Propofol is Effective to Depress Fentanyl-Induced Cough during Induction of Anesthesia

Abstract

BackgroundVarious attempts have been made to reduce the incidence of fentanyl-induced cough during anesthesia induction. We hypothesized that an appropriate dose of propofol might suppress fentanyl-induced cough.ObjectivesA study had been designed to observe the effects of propofol on a fentanyl-induced cough during anesthesia induction.Patients and MethodsWe performed a randomized, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous propofol (20 mg) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Group 1 patients were given fentanyl at a dosage of 4 µg/kg. Group 2 received 4µg/kg fentanyl and 20 mg propofol. The two groups were evaluated in 0, 5 and 10 second intervals following the injection of fentanyl.ResultsMean age, weight, and, height was 35 ± 10.45, 67.99 ± 10.92, and 165.33 ± 31.84 respectively. The incidence of fentanyl induced cough was 29 (74.4%) in placebo group compared with 10 (25.6%) in the propofol group. There was a significant difference in the incidence and severity of cough between group 1 and 2 (P < 0.0001). This study also showed that propofol could decrease cough incidence in patients who smoke.ConclusionsPriming dose of propofol (20mg) one minute prior to fentanyl injection was effective in suppressing a fentanyl-induced cough.

全麻诱导期经静脉输液管缓慢滴注和快速输注芬太尼对该药诱发呛咳的影响

“…Previous studies with several anesthetic adjuncts, such as sodium chromoglycate (Agarwal et al, 2003), beclomethasone (Agarwal et al, 2003), dexmethorphan (Mukherjee et al, 2011), lidocaine (GecajGashi et al, 2013, salbutamol (Saleh et al, 2014), dexmedetomidine (Saleh et al, 2014), ketamine (Saleh et al, 2014), propofol (Sedighinejad et al, 2013;Firouzian et al, 2015), dezocine (Xu et al, 2015), magnesium sulphate (Liu et al, 2015) and butorphano (Cheng et al, 2016), have been demonstrated to effectively decrease FIC. However, there was no unified standard, and the use of preventative drugs might produce other drug-related complications, thus prophylactic use of drugs should be strictly limited.…”

“…Sedighinejad et al (2013) from Iran observed 74.4% of FIC when patients directly received 4 µg/kg fentanyl (Fentanylhamlen Pharmaceutical Co., Germany) while the rate dropped to 25.6% with a pre-emptive use of 20 mg propofol (Pofol 1%, Dangkook Pharm. Co., Ltd., Korea).…”

“…It is particularly dangerous for those patients suffering from airway diseases, acute upper airway obstruction, cerebral aneurysm, increased intracranial pressure, brain trauma, brain hernia, or dissecting aortic aneurysm, as severe FIC could lead to pneumothorax, optic nerve injury, or rupture of aneurysms (Lim et al, 2013;Saleh et al, 2014;Firouzian et al, 2015;Park et al, 2016;Peringathara and Robinson, 2016). In clinical settings, the reported incidence of FIC is variable (18.0%-74.4%) depending on the dosage, infusion speed, and route of administration (Sedighinejad et al, 2013;Solanki et al, 2016). Exploring a simple, safe, and effective way to reduce FIC, especially for those who have poor tolerance to cough, is therefore of utmost importance.…”

“…Several drugs have been used thus far, in an attempt to reduce FIC during general anesthesia induction, such as dexmethorphan (Mukherjee et al, 2011), lidocaine (Gecaj-Gashi et al, 2013, ketamine (Saleh et al, 2014), dexmedetomidine (Saleh et al, 2014), propofol (Sedighinejad et al, 2013;Firouzian et al, 2015), magnesium sulphate (Liu et al, 2015), dezocine (Xu et al, 2015), and butorphanol (Cheng et al, 2016). Non-pharmacological methods have also been used to successfully reduce FIC, such as prolonging the injection time (Lin et al, 2005) and diluting the fentanyl with saline (Solanki et al, 2016).…”

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

“…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]. FIC could even cause severe upper airway obstruction and aspiration pneumonia that require immediate intervention [6,7].…”