Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough

Abstract

P Pu ur rp po os se e: : The aim of this study was to evaluate the effectiveness of lidocaine, propofol and ephedrine in suppressing fentanyl-induced cough.M Me et th ho od ds s: : One hundred and eighteen patients were randomly assigned into four groups and the following medications were given intravenously: patients in Group I (n = 31) received normal saline 2 mL, Group II (n = 29) received lidocaine 2 mg·kg and Group IV (n = 28) received ephedrine 5 mg. At one minute after the study medication, fentanyl 2.5 µg·kg -1 was given intravenously within two seconds. The occurrence of cough and vital sign profiles were recorded within two minutes after fentanyl bolus by an anesthesiologist blinded to study design.R Re es su ul lt ts s: : Sixty-five percent of patients in the placebo group had cough, whereas the frequency was significantly decreased in Groups II (14%) and IV (21%). Although a numerically lower frequency of cough was noted in Group III (37%), it was not statistically different from that of the placebo group. SpO 2 decreased significantly in patients of Group III compared to placebo; one patient experienced hypoxemia necessitating mask ventilation. Patients in Group III showed a decrease in heart rate and systolic blood pressure (2 beats·min

The effect of dilution and prolonged injection time on fentanyl‐induced coughing*

“…Our study has shown that undiluted fentanyl, when administered through a peripheral venous line, provokes coughing in up to 32% of patients. Previous studies [1][2][3][4][5][6][7] have shown that the incidence of fentanyl-induced cough varies between 18% and 65%. In the study by Lin et al [1], 65% of the patients coughed following 2.5 lg.kg )1 fentanyl through a peripheral venous line within 2 s. A 46% incidence of cough has been reported with 7 lg.kg )1 fentanyl administered through a central venous catheter administered over 1 s by Bohrer et al [2].…”

“…Previous studies [1][2][3][4][5][6][7] have shown that the incidence of fentanyl-induced cough varies between 18% and 65%. In the study by Lin et al [1], 65% of the patients coughed following 2.5 lg.kg )1 fentanyl through a peripheral venous line within 2 s. A 46% incidence of cough has been reported with 7 lg.kg )1 fentanyl administered through a central venous catheter administered over 1 s by Bohrer et al [2]. Another study by Lui et al [3] showed that 43% of patients coughed after receiving 5 lg.kg )1 fentanyl injected through a peripheral venous line over 5 s. Pandey et al [4] reported that 35% of patients coughed following 3 lg.kg )1 fentanyl given intravenously through a peripheral venous line.…”

“…Fentanyl has been shown to inhibit central sympathetic outflow, causing vagal predominance, inducing cough and reflex bronchoconstriction, and it has also been shown to elicit cough by stimulating irritant receptors in tracheal smooth muscle [3,6,11]. Lin et al [1] and Bohrer et al [2] suggest that pulmonary chemoreflex is the likely mechanism, mediated by either irritant receptors (rapidly adapting receptors) or vagal C fibre receptors in close proximity to pulmonary vessels (juxta capillary receptors). On the other hand, suppression of cough with betamethasone inhalation supports the trigger stimulus and bronchial hyperirritability theory [3,6,8].…”

“…Fentanyl is commonly administered prior to induction of anaesthesia because of its rapid onset, short duration of action, intense analgesia, cardiovascular stability, and no histamine release. However, previous studies [1][2][3][4][5][6][7] have found that a pre-induction bolus dose of fentanyl sometimes causes coughing. The incidence of fentanyl-induced cough varies between 18% and 65%.…”

Suppressing Effect of Dextromethorphan or Clonidine on Fentanyl- Induced Coughing: A Double- Blind, Prospective, Randomized Placebo- Controlled Study

“…Fentanyl-induced cough could also be the result of a mechanical or chemical stimulation of sensory receptors within the respiratory tract; the afferent impulses from these receptors may activate a putative brainstem cough center [7]. Drugs such as ketamine, terbutaline, clonidine, dexamethasone, and lidocaine as well as performing some maneuvers such as a forced expiration against open glottis, dilution of fentanyl to 10 μg/ ml, and prolonged injection time have all been evaluated in reducing this fentanyl induced cough [8][9][10][11][12][13]. Dextromethorphan is an antitussive drug that is used for suppression of cough caused by minor throat and tracheo-bronchial irritation, especially after inhalation of any irritants.…”