The frequency of fentanyl-induced cough in children and its effects on tracheal intubation

Han, Jong In; Lee, Heeseung; Kim, Chi Hyo; Lee, Guie Yong

doi:10.1016/j.jclinane.2009.01.019

Cited by 20 publications

(20 citation statements)

References 18 publications

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“…Some authors have reported that severe fentanyl-induced cough (FIC) can cause multiple conjunctival and periorbital petechiae [ 7 ], and explosive, spasmodic coughing leads to massive engorgement of tongue and hypopharynx that can cause acute airway obstruction and severe hypoxia [ 8 ]; both these occurrences were reported in the pediatric population. In addition, since FIC is more common in children, occurring even after the administration of small doses and a more severe episode can develop after the administration of larger doses [ 9 , 10 ]; prevention of opioid-induced cough is particularly important in children. Meanwhile, prolongation of the injection time is a simple and safe method to effectively suppress FIC [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of injection speed on remifentanil-induced cough in children

Kim

Yoo

Moon

et al. 2014

Korean J Anesthesiol

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BackgroundRemifentanil sometimes elicits cough during induction of anesthesia, as with the use of other fentanyl congeners. We designed this study to investigate the incidence of remifentanil-induced cough (RIC) in children and to evaluate the effect of injection speed on RIC.MethodsOne hundred twenty ASA physical status I-II patients, aged 3-12 yr, undergoing general anesthesia were enrolled in the study. Patients were randomly assigned to one of the three groups. Patients in Group R30 received remifentanil 1.5 µg/kg at a constant rate over 30 s. Patients in Group R45 received remifentanil 1.5 µg/kg over 45 s, and patients in Group R60 received remifentanil 1.5 µg/kg over 60 s, respectively. Episodes of cough were recorded and graded as mild (1-2), moderate (3-4), or severe (5 or more). Mean arterial pressure (MAP), heart rate (HR), and SpO2 were recorded on arrival in the operating room (baseline) and 1 min after remifentanil infusion.ResultsThe incidence of RIC was 33.3% in Group R30 (13 of 39 patients), 17.9% in Group R45 (7 of 39 patients), and 5.0% in Group R60 (2 of 40 patients). Patients in Group R60 had a significantly lower incidence of RIC than those in Group R30 (P = 0.001). The MAP, HR, and SpO2 values were not significantly different between groups.ConclusionsWhen intravenous remifentanil 1.5 µg/kg was administered in pediatric patients, the incidence of RIC decreased from 33 to 5% by increasing the injection time from 30 to 60 s. Remifentanil should be administered slowly over 60 s in children to suppress cough during anesthesia induction.

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Section: Introductionmentioning

confidence: 99%

The effect of injection speed on remifentanil-induced cough in children

Kim

Yoo

Moon

et al. 2014

Korean J Anesthesiol

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“…Coughing after fantanyl and remifentanyl intravenous administration has been reported in adults and children 79–82 and risk seems to be higher in this last group; 83 since coughing could represent a trigger of bronchospasm in asthmatic children, particular attention should be paid during and after their use.…”

Section: Intraoperative Managementmentioning

confidence: 98%

Update on Perioperative Management of the Child with Asthma

2012

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Asthma represents the leading cause of morbidity from a chronic disease among children. Dealing with this disease during the perioperative period of pediatric surgical procedures is, therefore, quite common for the anesthesiologist and other professionalities involved. Preoperative assessment has a key role in detecting children at increased risk of perioperative respiratory complications. For children without an optimal control of symptoms or with a recent respiratory tract infection elective surgery should be postponed, if possible, after the optimization of therapy. According to clinical setting, loco-regional anesthesia represents the desirable option since it allows to avoid airway instrumentation. Airway management goals are preventing the increase of airflow resistance during general anesthesia along with avoiding triggers of bronchospasm. When their use is possible, face mask ventilation and laringeal mask are considered more reliable than tracheal intubation for children with asthma. Sevoflurane is the most commonly used anesthetic for induction and manteinance. Salbutamol seems to be useful in preventing airflow resistance rise after endotracheal intubation. Mechanical ventilation should be tailored according to pathophysiology of asthma: an adequate expiratory time should be setted in order to avoid a positive end-expiratory pressure due to expiratory airflow obstruction. Pain should be prevented and promptly controlled with a loco-regional anesthesia technique when it is possible. Potential allergic reactions to drugs or latex should always be considered during the whole perioperative period. Creating a serene atmosphere should be adopted as an important component of interventions in order to guarantee the best care to the asthmatic child.

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“…Fentanyl and ketamine are among the drugs used widely in neonates and children, due to their rapid onset of action, short duration of effect, effective analgesic and anesthetic properties, and relatively safe respiratory and hemodynamic profiles (Bhutta, 2007; Han et al, 2010). Fentanyl is a potent synthetic opioid frequently used prior to induction of anesthesia; its advantages include intense analgesia as well as absence of histamine release (Adachi et al, 2002; Chung and Evans, 1985; Ko et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Fentanyl administration in infant rats produces long‐term behavioral responses

Medeiros

Souza

et al. 2011

Intl J of Devlp Neuroscience

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Considering the importance of studies in animal models that are focused on systems involved in pain mechanisms, this investigation aimed to evaluate the effects of pharmacological treatments on the behavioral responses of younger animals. To this end, we evaluated the effect of an acute dose of fentanyl (FEN) or S(+)-ketamine (KET) at postnatal day 14 (P14) upon behavioral responses in the short- (P14), medium- (P30) and long-term (P60) using the open field (OF), elevated plus-maze (EPM) and formalin tests (FT) and tail-flick latency. Fourteen-day-old male Wistar rats were divided into three groups: control (CT), fentanyl (FEN) and S(+)ketamine (KET) groups for statistical analysis, it was performed two-way ANOVA followed by Bonferroni. We found that, regardless of the test performed (OF or EPM), between-group differences occurred over time in all behaviors analyzed, including in the second phase of FT. In addition, EPM showed significant differences in behavioral responses related to acute administration (at P14) of fentanyl or S(+)-ketamine, in behaviors such as number of entries in open and closed arms, time spent in open and closed arms, and number of head-dipping. In relation to nociceptive response, the FEN group exhibited a decrease in the first phase of FT. These results indicate that unique administration of fentanyl or S(+)ketamine in an early period of life (P14) can promote changes in behavioral responses. In addition, our findings highlight the importance of extending the investigation of the effect of drug administration in young rats into adulthood.

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The frequency of fentanyl-induced cough in children and its effects on tracheal intubation

Cited by 20 publications

References 18 publications

The effect of injection speed on remifentanil-induced cough in children

The effect of injection speed on remifentanil-induced cough in children

Update on Perioperative Management of the Child with Asthma

Fentanyl administration in infant rats produces long‐term behavioral responses

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