SummaryOne hundred and ten male patients scheduled for coronary artery bypass grafting were allocated randomly into one of three groups. Patients in group A received fentanyl7 pg/kg via a central venous catheter, those in group B were given fentanyl7 pgikg through a peripheral venous cannula, and patients in group C received sterile water via a central venous catheter. In group A , 45.9% of patients coughed after injection of fentanyl; the mean onset time .from the end of fentanyl administration to the beginning of coughing was 10.6 seconds. Only one patient in group B and no patient in the control group exhibited a cough response ( p < 0.0001). We hypothesise that fentanyl can evoke the pulmonary chemoreflex. Key wordsAnaesthetics, intravenous; fentanyl. Complications; cough.The opioid agonist fentanyl has been used as an anaesthetic adjunct as well as the sole anaesthetic for almost two decades.'-3 Common side effects of fentanyl such as respiratory depression have been reported and studied in detail.-Lately, the focus has shifted to the discussion of complications such as chest-wall and extremely rare seizures associated with fentanyl administration.'&'* This clinical study deals with a side effect of fentanyl which has not been reported previously. Materials and methodsOne hundred and fifty male patients scheduled for coronary artery bypass grafting gave their informed consent to participate in this institutionally approved study. Exclusion criteria were poor left ventricular function, critical left mainstem stenosis and a history of pulmonary disease including coughing. Patients were premedicated with midazolam 0.1 mg/kg intramuscularly 30 minutes before arrival in the operating room. One peripheral venous cannula was placed in the dorsum of the hand before induction of anaesthesia, and a central venous catheter was inserted via an antecubital vein using intravascular electrocardiography."-I5 Both procedures were completed successfully in 1 1 1 patients. Baseline haemodynamic variables and the degree of sedation were recorded. One patient was eliminated from the study because of unexpected coughing before randomisation. The remaining 110 patients were allocated randomly into one of three groups. Patients in group A (n = 37) received a bolus of fentanyl 7 pg/kg administered through the central venous catheter over one second. Patients in group B (n = 37) were given fentanyl 7 pg/kg through the peripheral venous line, also over one second. Sterile water in an amount equivalent to the corresponding volume of fentanyl was administered to patients in group C (n = 36) via the central venous catheter, again over one second. All injectates were at room temperature.All patients were observed carefully in order to detect a cough response after injection of fentanyl or sterile water. The onset time from the end of bolus administration until the beginning of coughing was measured using a stopwatch. Where appropriate, the coughing intensity was recorded. The degree of sedation at the time of injection was noted simultan...

Between January 1988 and December 1997 a total of 22 patients (age: 8 days-46 years) were operated for vascular airway compression syndromes with respiratory insufficiency. Vascular anomalies in tracheal compression were double aortic arch in 7 patients, (2 previously operated elsewhere), right aortic arch + left ligamentum arteriosum in 1, and pulmonary artery sling in 3. Three of these patients had secondary long-segment tracheomalacia. Compression of trachea and a main bronchus existed in 2 patients with right aortic arch + left ligamentum. Isolated main bronchus obstruction was present in 9 patients (abnormal insertion of ligamentum arteriosum in 1, status post (s.p.) previous operation for PDA in 4, s. p. surgery for coarctation in 1, right aortic arch + left ligamentum arteriosum in 2, and right lung aplasia + left ligamentum in 1). 3 of these cases had secondary long-segment bronchomalacia. All patients had a complex respiratory anamnesis [long-term intubation in 7, s.p. tracheostomy in 2 (over 3 months - 3 years), and progressive respiratory insufficiency in 13). In tracheal compression, surgical correction included transsection of the underlying ring or sling components (with additional anterior aortic arch translocation in 5 patients resection-reimplantation of left pulmonary artery in 3, segmental tracheal resection in 1, and external tracheal suspension in 2). In the 2 cases with compression of the trachea and a main bronchus, aortic "extension" by a prosthetic tube was necessary. In isolated main bronchus obstruction, surgical decompression basically consisted of transsection of the ligamentum arteriosum or resection of its scarry remnant forming the "corner point" of a compression between aorta and pulmonary artery. In 3 patients with secondary long-segment malacia, additional external bronchus suspension was performed. Effective decompression and re-expansion of the airway segment concerned was achieved, and was demonstrated by intraoperative endoscopy in all patients. There were 3 postoperative deaths (sepsis 2; massive, irreversible edema of the tracheal mucosa 1). Of the 19 surviving patients 16 could be extubated between the 1st and 17th (mean = 7.5) postoperative day. In 1 case the preoperative long-term tracheostomy had to be left in place for inoperable additional laryngeal stricture. 2 patients had to be reoperated (segmental cervical tracheal resection after 5 months for primary long-term intubation-related subglottic stenosis in 1, esophageal decompression for residual dysphagia after 57 months related to a traction phenomenon at the right descending aorta in the other), both with gratifying results. In all other patients clinical, endoscopic, and radiographic examinations (follow-up = 2 months - 6 years) demonstrate good results.

The agreement between PCCO and ICO in contrast to CCO in the first 45 min after HCPB indicates that CCO underestimates CO during this period.

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