Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis

Abstract

Fentanyl-induced cough (FIC) is often observed after intravenous bolus administration of fentanyl during anesthesia induction. This meta-analysis assessed the efficacy of pharmacological and nonpharmacological interventions to reduce the incidence of FIC. We searched for randomized controlled trials comparing pharmacological or nonpharmacological interventions with controls to prevent FIC; we included 28 studies retrieved from Pub-Med, Embase, and Cochrane Library. Overall incidence of FIC was approximately 31 %. Lidocaine [odds ratio (OR) = 0.29, 95 % confidence interval (CI) 0.21–0.39], N-methyl-D-aspartate (NMDA) receptor antagonists (OR 0.09, 95 % CI 0.02–0.42), propofol (OR 0.07, 95 % CI 0.01–0.36), a2 agonists (OR 0.32, 95 % CI 0.21–0.48), b2 agonists (OR 0.10, 95 % CI 0.03–0.30), fentanyl priming (OR 0.33, 95 % CI 0.19–0.56), and slow injection of fentanyl (OR 0.25, 95 % CI 0.11–0.58)] were effective in decreasing the incidence of FIC, whereas atropine (OR 1.10, 95 % CI 0.58–2.11) and benzodiazepines (OR 2.04, 95 % CI 1.33–3.13) were not effective. This meta-analysis found that lidocaine, NMDA receptor antagonists, propofol, a2 agonists, b2 agonists, and priming dose of fentanyl were effective in preventing FIC, but atropine and benzodiazepines were not. Slow injection of fentanyl was effective in preventing FIC, but results depend on the speed of administration.

Suppression of fentanyl-induced cough. A priming dose of intravenous dexmedetomidine–magnesium sulfate: A double blind, randomized, controlled study

“…Bronchoconstriction was expected to be the engine of this cough reflex, so bronchodilators (selective b2 agonist) inhalation was used. Others such as lidocaine, Nmethyl-D-aspartate (NMDA) receptor antagonists, atropine, propofol, midazolam and slow administration of fentanyl were tried [7,8]. Dexmedetomidine (DEX) is a specific a2-receptor agonist, used to reduce anxiety and tension and to promote relaxation and sedation with hemodynamic stability [9].…”

Intravenous Lidocaine for the Prevention of Cough: Systematic Review and Meta-analysis of Randomized Controlled Trials

“…Two systematic reviews have described the efficacy of IV lidocaine for the prevention of fentanyl-induced cough. 17,18 It remains unclear though whether IV lidocaine is equally effective for the prevention of mechanically induced cough (eg, during tracheal intubation) as for the prevention of BACKGROUND: It remains unclear to what extent intravenous lidocaine prevents cough and whether there is dose-responsiveness and risk of harm. METHODS: We searched electronic databases to January 1, 2017 for randomized trials comparing intravenous lidocaine with placebo for the prevention of cough in surgical patients.…”

Fentanyl-induced cough is a risk factor for postoperative nausea and vomiting

“…Effective ways to prevent FIC include pretreatment with propofol, N-methyl--aspartate receptor antagonists, β 2 agonists, lidocaine, α 2 agonists, giving a small fentanyl dose 1-3 min before a larger fentanyl dose, or by slowing the rate of fentanyl injection. 15 Cigarette smoking and increasing patient age also decrease the incidence of FIC. 16 Benzodiazepines and atropine do not decrease the incidence of FIC.…”

“…16 Benzodiazepines and atropine do not decrease the incidence of FIC. 15 The mechanism of FIC in humans is unknown. However, histamine appears to be involved in the production of FIC in mice.…”