Preemptive use of Small Dose Fentanyl Suppresses Fentanyl Induced Cough

Abstract

Background Fentanyl, a synthetic opioid, is a popular choice amongst anaesthesiologists in the operating room. Pre induction intravenous fentanyl bolus is associated with coughing in 28 – 65% of patients. Fentanyl induced cough is not always benign and can be remarkably troublesome at the most critical moment of anaesthesia when airway reflex is lost. Objectives To study the effect of pre emptive use of minimal dose fentanyl through the peripheral venous cannulae on the incidence of cough by a larger bolus of intravenous fentanyl. Methods One hundred and fifty patients aged 18 -75 years undergoing elective surgical procedures were randomized into three groups of 50 each. The first group received 0.5 ml saline 0.9 % intravenously one minute prior to the administration of fentanyl 150μg (3 ml); the second group received pre emptive fentanyl 25μg(0.5ml) prior to the administration of fentanyl 125μg(2.5ml); and the third group received preemptive fentanyl 25 μg(0.5ml), followed by the administration of fentanyl 150μg(3ml).. Based on the number of coughs observed, cough severity was graded as mild(1-2), moderate (3-5),or severe (>5). Results The incidence of fentanyl induced cough was significantly lower in both pre emptive group 4(8%) for 125μg fentanyl and 7(14%) for 150μg than in the saline group 15(30%). Conclusion Pre- emptive use of minimal dose fentanyl 25μg administered one minute before a larger bolus dose of fentanyl (125 or 150μg ) can effectively suppress cough. DOI: http://dx.doi.org/10.3126/kumj.v10i4.10988 Kathmandu Univ Med J 2012;10(4):16-19

Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial

“…Fentanyl is commonly used as a potent, synthetic opioid analgesic with a rapid onset and short duration of action. Latest studies demonstrated that pre-emptive low dose of fentanyl could effectively prevent fentanyl-induced cough [ 9 , 11 ]. Epidural Fentanyl has also been shown to have pre-emptive analgesia effects.…”

Comparing the different oxycodone doses of prevent oxycodone for prevention of preventing fentanyl‐induced cough during induction of general anaesthesia

“…Another possible mechanism was that fentanyl administration could stimulate tracheal smooth muscle constriction located in proximity to pulmonary vessels. [12][13][14] This study demonstrated that cough severity and incidence were significantly higher in the Sham group intravenous administration with normal saline. However, intravenous oxycodone 0.075 and 0.100 mg/kg was found to reduce FIC incidence significantly; the inhibitory effect was dose-dependent.…”

“…Regarding previous literature, the mechanism of cough incidence suppression may be explained by the fact that when oxycodone was given, some cough-related receptors could be occupied, thereby blocking its combination with fentanyl. [14][15][16] On the one hand, this mechanism was speculated to directly inhibit the excitement of the medulla oblongata cough centre, thereby producing the antitussive effect. On the other hand, it may act on the trachea and bronchial tree muon through κ receptors, with suppression of the reflex tube contraction producing the antitussive effect.…”

Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis

“…Fentanyl is one of the widely used opioids as a pre-induction aid due to its rapid onset, short duration of action, intense analgesia, cardiovascular stability, and low histamine release. However, coughing is one side effect of fentanyl, occurring in 28–65% of patients and raising concern among anaesthesiologists 1 – 4 . Fentanyl-induced cough (FIC) usually occurs within two minutes after fentanyl injection.…”