Effects of different priming doses of propofol on fentanyl-induced cough during anesthesia induction: A preliminary randomized controlled study

Abstract

Fentanyl-induced cough is not an uncommon condition during the induction of general anesthesia. A preliminary randomized controlled study was designed to observe the effects of different priming doses of propofol on fentanyl-induced cough during anesthesia induction. A total of 120 patients were randomized into 4 groups (n = 30) to receive the intravenous injection of intralipid (group I), propofol 1 mg·kg-1 (group II), propofol 1.5 mg·kg-1 (group III), or propofol 2 mg·kg-1 (group IV) 1 minute before a bolus of fentanyl 2.5 µg·kg-1. The occurrence and severity of cough were recorded for 2 minutes after fentanyl bolus. The severity of cough was graded as none (grade 0), mild (grade 1–2), moderate (grade 3–4), or severe (grade 5 or more). The average bolus time of fentanyl was 1.5 ± 0.3 seconds in the present study. The incidence of fentanyl-induced cough was 80.0% in group I, 40.0% in group II, 6.7% in group III, and 3.3% in group IV, respectively. Groups II, III, and IV had a lower incidence and less severity of cough than group I (P < 0.05). Groups III and IV had a lower incidence and less severity of cough than group II (P < 0.05). In summary, a priming dose of more than 1 mg·kg-1 of propofol is effective to suppress fentanyl-induced cough in a dose-dependent manner. We suggest using a priming dose of propofol 1.5 mg·kg-1 to suppress cough during the anesthesia induction with propofol and fentanyl in clinical practice.

Effect of intravenous dezocine on fentanyl-induced cough during general anesthesia induction: a double-blinded, prospective, randomized, controlled trial

“…For example, betamethasone and dexamethasone are steroids and should be used under strict conditions; ephedrine can cause hemodynamic changes; lidocaine does not have a significant influence on the severity of cough; ketamine is scarcely used in adult general anesthesia, especially in patients with hypertension, elevation of intracranial pressure, and intraocular pressure. In a study involving the pre-injection of propofol as a measure to suppress fentanyl-induced cough, the incidence of cough in the propofol group (recommended dose 1.5 mg/kg) was approximately 6.7% [13]. An overdose of propofol may cause fluctuation of hemodynamics.…”

“…Many factors have been associated with fentanyl-induced cough, such as drug dosage and concentration, order of drug administration, intravenous injection rate and site [8], individual physical condition, age, sex, weight, disease history, smoking, and family genetics. A number of techniques have been applied to reduce the incidence of fentanylinduced cough, including the use of betamethasone (8.3 vs. 35%), dexamethasone (6.3 vs. 21.3%) [9], ephedrine (21 vs. 65%) [10], lidocaine (13.1%) [11], ketamine (7.2 vs. 21.6%) [12], and propofol (6.7%) [13], a change the order of administering the drugs, the speed of fentanyl administration, and fentanyl concentration. The use of the drugs in these earlier studies was unable to completely prevent fentanyl-induced cough, and some of them are very limited in terms of their clinical application.…”

Preemptive use of Small Dose Fentanyl Suppresses Fentanyl Induced Cough

“…21 Many physical methods and drugs havebeen reported to prevent fentanyl induced cough, including ephedrine, lidocaine, and propofol. 7,8,22 A huffing maneuver was reported as a useful way to prevent fentanyl induced Original Article cough, but some patients who receive midazolam or propofol during induction of general anesthesia cannot use this maneuver. 14 Although the above mentioned medications could reduce the incidence of coughing, some unexpected side effects may occur during drug administration, such as malignant arrhythmia, hypotension, and hypertension.…”

“…14 Using high doses of propofol can be associated with high incidence of hypotension. 22 Pretreatment with clonidine is associated with respiratory depression, drowsiness, and severe hypotension. 11 All these drugs and maneuver which have been tried to attenuate the fentanyl induced cough may not only be more costly but it may also be unnecessary.…”

Optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough suppression: a prospective randomized controlled trial

“…Fentanyl is used widely for general anesthesia induction due to its rapid onset, intensive analgesia and cardiovascular stability; however, an irritating cough may be caused after its intravenous (IV) administration [1]. The incidence of fentanyl-induced cough (FIC) can reach 80% [2]. The FIC may be transitory and limited; however, it can be explosive and detrimental especially in patients with increased intracranial, intraocular, intrathoracic, or intra-abdominal pressure [3][4][5].…”