Identification of independent risk factors for fentanyl-induced cough

Abstract

Purpose:To determine how the probability of fentanyl-induced cough is affected by patient characteristics and/or anesthetic technique. Methods:We analyzed data from a cohort of 1,311 adult patients undergoing elective surgery under general anesthesia, accompanied by iv fentanyl. The following data were collected: patient demographics, history of cigarette smoking, presence of bronchial asthma or chronic obstructive pulmonary disease, administration of angiotensin converting enzyme inhibitors; and anesthetic technique, including: preanesthetic anxiolytic medication, prior use of atropine, epidural lidocaine, a priming dose of vecuronium, and the dose of iv fentanyl. Associations between individual variables in the clinical evaluation model and the likelihood of fentanyl-induced cough were characterized by calculating odds ratios. Multiple logistic regression analysis was used to examine the independent contribution of each variable while controlling for all variables.Results: Fentanyl-induced cough was independently associated with the following: aging, cigarette smoking, a prior epidural injection of lidocaine, and a priming dose of vecuronium. Fentanyl-induced cough was unaffected by gender, the presence of either bronchial asthma or chronic obstructive pulmonary disease, or prior use of atropine. Conclusions:Fentanyl-induced cough may be suppressed by aging, cigarette smoking, prior epidural injection of lidocaine, or a priming dose of vecuronium. These findings may allow insights into the mechanism of this phenomenon, thereby leading to its prevention. Objectif

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

“…12 and the position of the injection site (peripheral as opposed to the central route) 13 have both been shown to reduce FIC. Patients in the present study were injected with undiluted fentanyl via the peripheral route (in the forearm) over 3 − 5 s. Age has been reported as a risk factor for FIC, 1,6,29 but the present study did not find such an association. This may be due to the wide age range of the patients studied (18 -75 years); a younger cohort might have revealed a difference in FIC.…”

The effect of pre‐emptive use of minimal dose fentanyl on fentanyl‐induced coughing

“…We excluded all patients with a history of asthma, chronic obstructive airway disease, upper respiratory infection within the 2 weeks leading up to their surgery, a history of bronchodilator or steroid therapy, or treatment with angiotensin-converting enzyme inhibitors. As cigarette smoking has been reported to suppress fentanyl-induced cough [8,9], the smoking status of all patients was assessed before fentanyl was administered. A current smoker was defined as someone who was still smoking, or had stopped smoking for < 6 months, and a non-smoker as one who had never smoked, or had stopped smoking for more than 6 months.…”

“…Care was also taken to determine the ideal time to administer the pre-emptive dose of fentanyl. Fentanylinduced cough has been reported to occur within 15 ) 20 s after administration of intravenous fentanyl [6,9]. We decided to administer the pre-emptive fentanyl 1 min before the larger bolus dose of fentanyl, to ensure that the pre-emptive dose had completed one arm-brain circulation time.…”

Posing the research question: not so simple

“…27 According to the PICOT criteria, the missing elements in this objective include specification of: (1) (i.e., how fentanyl-induced cough is measured); and (4) the time frame. Restating the objective using PICOT criteria would generate the following: ''In patients undergoing elective surgery under general anesthesia accompanied by intravenous fentanyl, are the type of pre-anesthesic medications (benzodiazepines, clonidine, hydroxyzine) and patient characteristics associated with increased risk of fentanyl-induced cough measured by development of bronchial asthma one minute following the administration of intravenous fentanyl?…”