Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced byiv fentanyl

Abstract

P Pu ur rp po os se e: : Fentanyl, a synthetic opioid, is a popular choice amongst anesthesiologists in the operating room. Preinduction iv fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times may be explosive requiring immediate intervention. We have studied the role of aerosol inhalation of salbutamol, beclomethasone and sodium chromoglycate in preventing fentanyl induced coughing and have compared their efficacy.M Me et th ho od ds s: : Two hundred patients aged 18-60 yr, undergoing elective laparoscopic cholecystectomy were randomized into four groups of 50 each. Group I served as control, while Groups II, III and IV received an aerosol inhalation of salbutamol, beclomethasone or sodium chromoglycate 15 min prior to entering the operating room. Following iv fentanyl (2 µg·kg -1 ) the incidence of cough was recorded and graded as mild (1-2), moderate (3-5) and severe (> 5) depending on the number of coughs observed. Results were analyzed using 'z' and Fischer's Exact test. A P value of # 0.05 was considered significant. R Re es su ul lt ts s: : The incidence of cough was 28% in the control group, 6%, 0% and 4% in the salbutamol, beclomethasone and sodium chromoglycate groups respectively. Occurrence of cough was significantly low (P # 0.05) in the treatment groups, however the difference amongst the groups was not significant (P $ 0.05).

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

“…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. Phua et al [5] found that fentanyl 1.5 lg.kg )1 when administered via a peripheral venous line elicited a cough in 28% of the patients and a similar incidence of cough was observed by Agarwal et al [6] following 2 lg.kg…”

“…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].…”

“…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%.…”

“…Another study demonstrated that the inhalation of terbutaline, a selective b 2 -adrenergic bronchodilator, could effectively suppress this reflex [3]. More recently, Agarwal et al [6] reported that aerosol inhalation of salbutamol, beclomethasone or sodium chromoglycate 15 min prior to entering the operating room could also reduce the incidence of cough. However, these methods can be inconvenient and increase cost, so their clinical acceptance is somewhat limited.…”

Fentanyl-induced cough during general anesthesia: a different perspective

“…In addition, they found the incidence of FIC to be positively correlated with the dose of fentanyl used, as suggested by our observations. However, there are cases where FIC is particularly undesirable such as in patients with cerebral aneurysms, brain trauma, open eye injury, dissecting aortic aneurysm, pneumothorax and hypersensitive airway disease [5]. In such cases, perhaps the method used by QiFeng Tang and co-workers is more suitable as it involves the administration of a single agent, thus avoiding any potential complications resulting from polypharmacy.…”