Effects of a Priming Dose of Fentanyl during Anaesthesia on the Incidence and Severity of Fentanyl-Induced Cough in Current, Former and Non-Smokers

Abstract

Fentanyl is commonly used during anaesthesia and can cause fentanyl-induced cough (FIC). This study investigated whether a priming dose of fentanyl reduced FIC, and determined the factors associated with increased risk of FIC. Subjects undergoing elective surgery under general anaesthesia ( n = 800) were randomized into four groups: group 1 received 2 μg/kg fentanyl bolus; groups 2, 3 and 4 received a priming dose of fentanyl 0.5 μg/kg followed by 1.5 μg/kg after 1, 2 or 3 min, respectively. The incidence of FIC was 17.0%, 10.0%, 12.5% and 11.5% for groups 1, 2, 3 and 4, respectively, with no significant between-group differences in FIC incidence or severity. The mean FIC onset time was 22 s. Former smokers were 2.91 times more likely than current smokers to experience cough. A fentanyl priming dose did not reduce the incidence and severity of FIC. Former smokers were hyper-reactive to fentanyl compared with current smokers.

Preemptive use of Small Dose Fentanyl Suppresses Fentanyl Induced Cough

“…16 Another study by Jung et al showed that priming dose of fentanyl didn't reduce the incidence and severity of fentanyl induced cough and former smokers were found to cough more than current smokers after injection of fentanyl. 18 Contradictory to their studies we didn't find any association between age and smoking status on the incidence of cough in any of the groups. This may be due to the wide age range of the patients studied (18 -75 years).…”

Comparison of the effects of pretreatment intravenous fentanyl or intravenous lidocaine on suppression of fentanyl-induced cough in children: a randomized, double-blind, controlled clinical trial

“…This action has probably been accomplished by the releasing of neurotransmitters that do not reach the threshold to induce cough. However, based on some studies, administrating the higher dose of fentanyl may cause an exhaustion of these neurotransmitters which lead to reduction of cough frequency ( 12 , 23 ). With this research, we found that injection of 0.5 μg/kg fentanyl as a priming dose can diminish the rate of FIC by 70% in children.…”

全麻诱导期经静脉输液管缓慢滴注和快速输注芬太尼对该药诱发呛咳的影响

“…Several mechanisms are described for FIC, including: (1) an inhibition of central sympathetic activity, leading to vagal predominance, causing reflex bronchial contract and inducing a cough (Rozé et al, 2011); (2) inducing pulmonary columnar epithelial cells to release histamine, which enhances cough sensitivity and causes bronchospasm (Kamei et al, 2013;el Baissari et al, 2014); (3) enhancing the excitability of rapidly adapting bronchial receptors or forming a reflex cough (Cinelli et al, 2013); (4) in combination with the μ receptors and κ receptors in the bronchial trees, activating the presynaptic C fiber to release neuropeptides, which cause bronchial smooth muscle contraction and increase vascular permeability, resulting in a choking cough (Jung et al, 2011;Cinelli et al, 2013); (5) the citric acid in citrate fentanyl can trigger bradykinin to be released by the peripheral tissue primary nerve, activating neurokinin-1 and neurokinin-2 receptors and causing neurogenic inflammation and bronchoconstriction and a choking cough (Kamei et al, 2013). All of these mechanisms are well studied; however, there are few methods that can effectively inhibit FIC.…”