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

Abstract

Abstract:Objective: Fentanyl-induced cough (FIC) is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoperative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether administering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods: A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists (ASA) grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 μg/kg via direct injection (control group) or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Results: Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction (9.1%, 95% confidence interval (CI): 6.7%-11.4% vs. 55.9%, 95% CI: 51.8%-60.0%, P=0.000), as were the severity grades (P=0.000). There were no statistical differences between the two groups with regard to other adverse reactions (P>0.05). Conclusions: The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.

Mechanism and Management of Fentanyl-Induced Cough

“…When the injection time was prolonged to 30 s, the incidence of cough decreased to 1.3% ( Lin et al, 2005 ). Administration of 2 μg⋅kg −1 fentanyl via a slow intravenous fluid line at rate of 0.058 µg⋅kg −1 ∙s −1 during induction reduced the incidence of FIC than via direct injection 9.1% vs. 55.9%, as were the severity grades ( Liu et al, 2017 ). There were no statistical differences between the two groups with regard to other adverse reactions.…”

Application via mechanical dropper alleviates sufentanil-induced cough: a prospective, randomized, single-blinded trial

“…There are three possible explanations for this inhibitory effect. First, when sufentanil was added to the mechanical dropper, it was diluted by the original liquid present in the dropper, the fluid coming from the infusion bag, and the mixture continuously dropping down to the flow tube [ 17 ]. In this research, the average patient weight in both groups was approximately 60 kg, with an induction dose of sufentanil of 0.3 μg·kg − 1 and an initial concentration of 5 μg·ml − 1 , the average dosage was around 18 μg, and the mean volume was 3.6 ml.…”

“…The estimation of sample size was based on a 16% reported incidence of SIC following an induction dose of sufentanil of 0.3 μg·kg − 1 [ 9 ]. A previous study reported a reduction of fentanyl-induced cough via mechanical dropper of approximately 84% [ 17 ], so we assumed that this simple method would cause at least an 80% decrease in the incidence of SIC. At α = 0.05 and β = 0.10, we needed to enroll 93 patients in each group; therefore, we recruited 200 patients to account for possible reduction in sample size due to patients dropping out.…”

“…A mechanical dropper, also known as a Murphy drip, an infusion set drip cup, or a drip chamber, is an infusion filtering apparatus with a variety of applications. In daily medical care, it can be used for intravenous degassing, observation of the infusion rate, or administration of special drugs when complications are associated with other methods of injection since there is a long intravenous fluid line from this apparatus to the end of the infusion set [ 16 , 17 ]. In this prospective and randomized study, we compared the effect of sufentanil application via T-connector or mechanical dropper on SIC, hypothesizing that the latter approach can help reduce the incidence of SIC.…”

<p>Anesthetic management in untreated Bland-White-Garland syndrome: a case report and literature review</p>

“…Fentanyl, has vagotonic effects that sometimes result in severe bradycardia, combined with propofol the result is particularly hypotensive 15. Bolus injection for anesthesia induction was not adopted, because blood concentration would rise sharply, and then the side effects of all the drugs are superimposed, leading to unwanted tachycardia and hypotension 16–19. Volatile agent for maintaining anesthesia is believed to have pleiotropic effects on protecting against myocardial ischemia, as well as maybe reduce the incidence of intraoperative awareness 6,20,21.…”