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

Abstract

Background To investigate the optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough (FIC) suppression. Methods Patients of 180 undergoing elective surgery with general anesthesia, aged 18–65 years, BMI 18.5–30 kg/m 2 , ASA I or II, were equally randomized into four groups ( n = 45) to receive intravenous pretreatment of dexmedetomidine with 0 (group 1), 0.3 (group 2), 0.6 (group 3) and 0.9 (group 4) mcg/kg over 10 mins, respectively. After the pretreatment, all patients were given a 5-s intravenous injection of fentanyl 4 mcg/kg. The symptoms of irritating cough including the severity and onset time were recorded for 1 min after fentanyl injection. General anesthesia induction was completed with midazolam, propofol and cisatracurium, then endotracheal tube or laryngeal mask was inserted and connected to an anesthesia machine. MAP, HR and SpO 2 at the beginning of pretreatment (T0), 3 min (T1), 6 min (T2), 9 min (T3) and 12 min (T4) after the beginning of pretreatment were recorded. Side effects of dexmedetomidine, such as bradycardia, hypertension, hypotension, and respiratory depression were also recorded during the course. Results Totally 168 patients completed the study. The incidences of cough were 52.4, 42.9, 11.9, and 14.3% in groups 1, 2, 3, and 4, respectively, with no significant differences between groups 1 and 2 ( P > 0.05) and between groups 3 and 4 ( P > 0.05). The incidence and severity of cough in groups 3 and 4 were significantly lower than those in groups 1 and 2 ( P < 0.05). Compared to T0, HR at T2 ( P < 0.05), T3 ( P < 0.01), and T4 ( P < 0.01) decreased significantly and MAP at T4 decreased significantly ( P < 0.05) in group 4. Bradycardia occurred in 1 case and respiratory depression occurred in 1 case in group 4. Compared to group 1, the onset time of cough in the other 3 groups were delayed significantly ( P < 0.05). Conclusion Pretreated dexmedetomidine 0.6 mcg/kg blous intravenous infusion over 10 mins could reduce FIC effectively without side effects. Trial registration This study was registered in ClinicalTrials.gov (NCT03126422), April 13, 2017.

WITHDRAWN: Comparison of a small dose of oxycodone and sufentanil for the prevention of sufentanil-induced cough during general anesthesia induction: a prospective randomized controlled trial

“…However, potential risks and additional side effects have limited their clinical application. Zhou et al [24] demonstrated that pretreatment with 0.6 μg/kg dexmedetomidine infused intravenously over 10 mins could significantly decrease the incidence and severity of fentanyl-induced cough. However, anesthesia induction may require a prolonged infusion, and dexmedetomidine may cause bradycardia (<50 beats/min), respiratory depression, and hypotension.…”

Mechanism and Management of Fentanyl-Induced Cough

“…The risk of bradycardia is significantly higher when the loading dose is greater than 0.7 μg•kg −1 (Tan and Ho, 2010). Pretreatment with dexmedetomidine intravenous infusion of 0.6 μg•kg −1 bolus given over 10 min reduced the severity of FIC effectively without adverse effects when fentanyl 4.0 μg•kg −1 was injected with the injection time of 5 s (Zhou et al, 2019).…”

Comparison of Five Prophylactically Intravenous Drugs in Preventing Opioid-Induced Cough: A Bayesian Network Meta-Analysis of Randomized Controlled Trials

“…A total of 877 citations were yielded by searching five online databases (Pubmed, Embase, Web of Science, Cochrane, and Google Scholar) by our search strategy. Based on the inclusion and exclusion criteria, 20 RCTs were finally identified and considered eligible for this network meta-analysis ( Figure 1 ) ( Lin et al, 2004 ; Pandey et al, 2004 ; Pandey et al, 2005 ; Yeh et al, 2007 ; Kim et al, 2008 ; Kim et al, 2009 ; Bang et al, 2010 ; Guler et al, 2010 ; Sun et al, 2011 ; He et al, 2012 ; Yu et al, 2012 ; Gecaj-Gashi et al, 2013 ; Honarmand et al, 2013 ; Sun and Huang, 2013 ; Saleh et al, 2014 ; Liu et al, 2015 ; Cheng et al, 2016 ; Naldan et al, 2019 ; Yin and Zhang, 2019 ; Zhou et al, 2019 ). Moreover, Table 1 summarizes the detailed information of individual studies enrolled in this network meta-analysis.…”

“…Kim et al found that a low dose of ketamine (0.1 mg/kg) was also effective in decreasing remifentanil-induced cough without influencing its severity and onset time ( Kim et al, 2009 ). Zhou et al also identified that the optimal dose of dexmedetomidine in the suppression of fentanyl-induced cough was 0.6 mg/kg, with no side effects ( Zhou et al, 2019 ). In summary, the optimal dose of different drugs for preventing OIC needs to be fully explored.…”