Mechanism and Management of Fentanyl-Induced Cough

Abstract

Fentanyl-induced cough (FIC) often occurs after intravenous bolus administration of fentanyl analogs during induction of general anesthesia and analgesia procedure. The cough is generally benign, but sometimes it causes undesirable side effects, including elevated intra-abdominal, intracranial or intraocular pressure. Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.

Magnesium sulphate pretreatment obtunds fentanyl-induced cough during general anaesthesia induction

“…The exact mechanism of fentanyl-induced cough is still unknown with several hypotheses proposed. 3 One of them suggested that fentanyl activates the μ opioid receptor, which then stimulates the rapidly adapting receptors present on the mucosa of the proximal tracheobronchial airway, causing bronchoconstriction and cough. 3,11 Another hypothesis suggests fentanyl inhibits central sympathetic outflow which stimulates the vagus nerve, producing bronchoconstriction and cough.…”

“…3 One of them suggested that fentanyl activates the μ opioid receptor, which then stimulates the rapidly adapting receptors present on the mucosa of the proximal tracheobronchial airway, causing bronchoconstriction and cough. 3,11 Another hypothesis suggests fentanyl inhibits central sympathetic outflow which stimulates the vagus nerve, producing bronchoconstriction and cough. 3 Therefore, the role of magnesium sulphate in obtunding fentanyl-induced cough was investigated in clinical trials based on its properties as a calcium antagonist and smooth muscle relaxant.…”

“…3,11 Another hypothesis suggests fentanyl inhibits central sympathetic outflow which stimulates the vagus nerve, producing bronchoconstriction and cough. 3 Therefore, the role of magnesium sulphate in obtunding fentanyl-induced cough was investigated in clinical trials based on its properties as a calcium antagonist and smooth muscle relaxant. 12,13 In this study, the incidence of fentanyl-induced cough in the control group was 11.4%, where the dose of fentanyl was 2 μg/kg delivered over 3 seconds.…”

“…1,2 However, one of its side effects during general anaesthesia induction is fentanyl-induced cough, ranging from 6.6% to 61.0%, depending on the dose and speed of injection. 3 A typical induction dose of 2 μg/kg was reported to produce a fentanyl-induced cough in 38% of patients. 4 Coughing can cause wide fluctuations of intrathoracic pressure, which stimulates the reflex activation of the sympathetic nervous system leading to stress on the cardiovascular system.…”

“…5 This effect could be detrimental in patients who suffer from hypertension, ischaemic heart disease, heart failure, high intraocular pressure, or intracerebral bleed. 3 obtained from all patients, who were fasted preoperatively for a minimum of 6 and 2 hours for solids and clear fluids, respectively. Premedication was not prescribed to all patients.…”