Prolonged Injection Time and Light Smoking Decrease the Incidence of Fentanyl-Induced Cough

Abstract

We designed this study to evaluate the effect of injection time and smoking on fentanyl-induced cough. Four-hundred-fifty ASA class I-II patients, aged 18-80 yr and weighing 40-90 kg, scheduled for elective surgery were included. All patients received fentanyl (100 microg for patients weighing 40-69 kg and 150 microg for patients weighing 70-90 kg for clinical convenience) via the proximal port of a peripheral IV line on the forearm. Patients were randomly assigned to 3 groups of 150 patients each. Patients in Group I received fentanyl injection over 2 s, whereas for patients in Groups II and III the fentanyl was injected at a constant rate over 15 s and 30 s, respectively. We recorded the number of coughs of each patient during and 30 s after fentanyl injection. The incidence of cough was 18% in group I, 8% in Group II, and 1.3% in Group III, significantly less (P < 0.05) with a longer injection time. Current smokers had a less frequent incidence of cough than nonsmokers; however, this effect was only significant in light smokers (<10 cigarettes per day or <10 smoking years or <10 pack-years). In conclusion, a longer injection time reduces the incidence of fentanyl-induced cough, and light smoking may be a protective factor against fentanyl-induced cough.

Lipid emulsion: is there sufficient knowledge among hospital staff?

“…I remain perplexed that researchers see so much of this problem, and wondered whether it was simply that they were using a higher dose of fentanyl compared to mine, but several of the papers these groups cite [5][6][7][8] used no more than 2 lg.kg )1 and still reported similar incidences.…”

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].…”

“…From the pharmacokinetic point of view, the duration of drug injection may affect the peak plasma concentration, with a longer injection time resulting in a smaller peak concentration. Lin et al [7] suggested that slowing the rate of injection reduced not only the incidence but also the severity of coughing. Schlimp et al [14] also proposed that the slow intravenous administration of fentanyl could prevent fentanyl-induced coughing and therefore clinicians should try to prolong the administration.…”

“…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%.…”

“…However, these methods can be inconvenient and increase cost, so their clinical acceptance is somewhat limited. In a recent study, Lin et al [7] suggested that prolongation of the injection time reduces the incidence of fentanyl-induced cough. In clinical practice, however, prolonged injection of undiluted fentanyl (50 lg.ml )1 ) is not easy to do.…”