Effect of preoperative incentive spirometry on fentanyl-induced cough: a prospective, randomized, controlled study

Abstract

BackgroundFentanyl-induced cough (FIC) has a reported incidence of 13–65% on induction of anesthesia. Incentive spirometry (IS) creates forceful inspiration, while stretching pulmonary receptors. We postulated that spirometry just before the fentanyl (F) bolus would decrease the incidence and severity of FIC.MethodsThis study enrolled 200 patients aged 18–60 years and with American Society of Anesthesiologists status I or II. The patients were allocated to two groups of 100 patients each depending on whether they received preoperative incentive spirometry before fentanyl administration. Patients in the F+IS group performed incentive spirometry 10 times just before an intravenous bolus of 3 µg/kg fentanyl in the operating room. The onset time and number of coughs after fentanyl injection were recorded as primary outcomes. Any significant changes in blood pressure, heart rate, or adverse effects of the drug were recorded as secondary outcomes.ResultsPatients in the F+IS group had a significantly lower incidence of FIC than in the F group (6% vs. 26%) (P < 0.05). The severity of cough in the F+IS group was also significantly lower than that in group F (mild, 5 vs. 17; moderate 1 vs. 7; severe, 0 vs. 2) (P < 0.05). The median onset time was comparable in both groups (9 s [range: 6–12 s] in both groups).ConclusionsPreoperative incentive spirometry significantly reduces the incidence and severity of FIC when performed just before fentanyl administration.

Mechanism and Management of Fentanyl-Induced Cough

“…Preoperative incentive spirometry has an important role in anesthesia practice, improving pulmonary function in patients with chronic obstructive and restrictive lung diseases and preventing postoperative atelectasis. Goyal et al (2017) found that preoperative incentive spirometry before giving fentanyl would suppress FIC, along with the secondary benefit of preventing postoperative pulmonary complications. Furthermore, Sako et al (2017) showed that swallowing action immediately before intravenous fentanyl also reduce the incidence of FIC from 40.4% to 14.0%.…”

Role of pre-emptive Huff's manoeuvre and acupressure in reducing the incidence of fentanyl induced cough; a risk factor for postoperative nausea vomiting in female patients: A prospective randomised controlled study

“…Estimated sample size was based on incidence of FIC in 32% population based on a previous study. [8] The α was taken to be 95%, the margin of error (d) was 5% and the value of P was estimated to be 32%. Total sample size was calculated as 334 so we took 112 patients in each group thus making the total sample size 336 for calculation purpose.…”

The effect of dexmedetomidine on decrease of cough, hemodynamic parameters and Ramsay score versus lidocaine during general anesthesia: a randomized clinical trial

“…It is undesirable and sometimes occurs as an attack, increasing intracranial, intraocular and intra-abdominal pressures. 4 5 Intravenous lidocaine (LID) affects and reduces the intensity of post-intubation cough owing to various causes, such as the laryngoscope blade type, straining during endotracheal extubation, and smoking. After the intubation, cuff inflation will pack around the ETT and irritate the trachea.…”

“…9 10 Range of methods is available, such as local and intravenous injection of topical anesthetics to reduce cough. 5 6 11 Furthermore, intravenous use of opioids is an alternative to reducing cough at the end of the operation and during endotracheal extubation, and when the patient does not complete awakening. 2 6 However, this has frequently not been desirable.…”