Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis
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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 PubMed, 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), α2 agonists (OR 0.32, 95 % CI 0.21–0.48), β2 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, α2 agonists, β2 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.
- Lin CS, Sun WZ, Chan WH, Lin CJ, Yeh HM, Mok MS. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough. Can J Anaesth. 2004;51:654–9. CrossRef
- Lin JA, Yeh CC, Lee MS, Wu CT, Lin SL, Wong CS. Prolonged injection time and light smoking decrease the incidence of fentanyl-induced cough. Anesth Analg. 2005;101:670–4. CrossRef
- Tweed WA, Dakin D. Explosive coughing after bolus fentanyl injection. Anesth Analg. 2001;92:1442–3. CrossRef
- Ambesh SP, Singh N, Srivastava K. Fentanyl induced coughing caused life-threatening airway obstruction in a patient with arteriovenous malformation of tongue and hypopharynx. Internet J Anesthesiol. 2009;20:7.
- Pandey CK, Raza M, Ranjan R, Lakra A, Agarwal A, Singh U, Singh RB, Singh PK. Intravenous lidocaine suppresses fentanyl-induced coughing: a double-blind, prospective, randomized placebo-controlled study. Anesth Analg. 2004;99:1696–8. CrossRef
- Horng HC, Wong CS, Hsiao KN, Huh BK, Kuo CP, Cherng CH, Wu CT. Pre-medication with intravenous clonidine suppresses fentanyl-induced cough. Acta Anaesthesiol Scand. 2007;51:862–5. CrossRef
- Yeh CC, Wu CT, Huh BK, Lee MS, Lin SL, J Sheen M, Wong CS. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth. 2007;19:53–6. CrossRef
- Lui PW, Hsing CH, Chu YC. Terbutaline inhalation suppresses fentanyl-induced coughing. Can J Anaesth. 1996;43:1216–9. CrossRef
- Hung KC, Chen CW, Lin VC, Weng HC, Hsieh SW. The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing. Anaesthesia. 2010;65:4–7. CrossRef
- Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive effect of a fentanyl bolus. Can J Anaesth. 1991;38:330–4. CrossRef
- Tang Q, Qian Y, Zhang Q, Yang J, Wang Z. Effects of different priming doses of propofol on fentanyl-induced cough during anesthesia induction: a preliminary randomized controlled study. Ups J Med Sci. 2010;115:121–4. CrossRef
- Higgins JPT, Green S, editors. Cochrane handbook for the systematic reviews of interventions. Version 5.0.2. Cochrane Collaboration; 2009.
- Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Reprint—preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Phys Ther. 2009;89:873–80.
- Viechtbauer W. Conducting meta-analyses in R with the metaphor package. J Stat Softw. 2010;36:1–48.
- Pandey CK, Raza M, Ranjan R, Singhal V, Kumar M, Lakra A, Navkar DV, Agarwal A, Singh RB, Singh U, Singh PK. Intravenous lidocaine 0.5 mg.kg−1 effectively suppresses fentanyl-induced cough. Can J Anaesth. 2005;52:172–5. CrossRef
- Guler G, Aksu R, Bicer C, Tosun Z, Boyaci A. Comparison of the effects of ketamine or lidocaine on fentanyl- induced cough in patients undergoing surgery: a prospective, double-blind, randomized, placebo-controlled study. Curr Ther Res Clin Exp. 2010;71:289–97. CrossRef
- He L, Xu JM, Dai RP. Dexmedetomidine reduces the incidence of fentanyl-induced cough: a double-blind, randomized, and placebo-controlled study. Ups J Med Sci. 2012;117:18–21. CrossRef
- Yu J, Lu Y, Dong C, Zhu H, Xu R. Premedication with intravenous dexmedetomidine-midazolam suppresses fentanyl-induced cough. Ir J Med Sci. 2012;181:517–20. CrossRef
- Jung HJ, Kim JB, Im KS, Cho HJ, Kim JW, Lee JM. Effects of a priming dose of fentanyl during anaesthesia on the incidence and severity of fentanyl-induced cough in current, former and non-smokers. J Int Med Res. 2011;39:2379–84. CrossRef
- Gu C, Zhou M, Wu H, Li F, Tang Q. Effects of different priming doses of fentanyl on fentanyl-induced cough: a double-blind, randomized, controlled study. Pharmacol Rep. 2012;64:321–5.
- Shrestha SK, Bhattarai B, Shah RS. Preemptive use of small dose fentanyl suppresses fentanyl induced cough. Kathmandu Univ Med J (KUMJ). 2012;10:16–9.
- Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D, Singh U. Salbutamol, beclomethasone or sodium cromoglycate suppress coughing induced by iv fentanyl. Can J Anaesth. 2003;50:297–300. CrossRef
- Dimitriou V, Spyrou A, Ioakimidou A, Stranomiti J, Koursoumi E, Atsalakis J, Saranteas T. The influence of premedication and smoking. Middle East J Anesthesiol. 2006;18:943–6.
- Ai Q, Hu Y, Wang Y, Wu S, Qin Z, Wang J, Wang G, Zhang J, An M. Pentazocine pretreatment suppresses fentanyl-induced cough. Pharmacol Rep. 2010;62:747–50.
- Sun ZT, Yang CY, Cui Z, Zhang J, Han XP. Effect of intravenous dezocine on fentanyl-induced cough during general anesthesia induction: a double-blinded, prospective, randomized, controlled trial. J Anesth. 2011;25:860–3. CrossRef
- Horng HC, Lin BF, Wang TC, Lin SL, Liaw WJ, Wang HJ, Wong CS. Priming dose of intravenous rocuronium suppresses fentanyl-induced coughing. Acta Anaesthesiol Taiwan. 2012;50:147–9. CrossRef
- Mukherjee A, Kundu AK, Ghosh S, Choudhuri R, Bandopadhyay BK, Dasgupta S. Pre-emptive oral dexmethorphan reduces fentanyl-induced cough as well as immediate postoperative adrenocortico-tropic hormone and growth hormone level. J Anaesthesiol Clin Pharmacol. 2011;27:489–94. CrossRef
- Elmenesy TM, Hamden GA, Abo Eldahab HA, El Abd NA. Dextromethorphan reduced fentanyl induced cough and stress hormones release A randomized double blind controlled study. Egypt J Anaesth. 2011;27:25–30. CrossRef
- Ambesh SP, Singh N, Gupta D, Singh PK, Singh U. A huffing manoeuvre, immediately before induction of anaesthesia, prevents fentanyl-induced coughing: a prospective, randomized, and controlled study. Br J Anaesth. 2010;104:40–3. CrossRef
- Schäpermeier U, Hopf HB. Fentanyl-induced cough does not depend on injection speed: a randomized study. Acta Anaesthesiol Scand. 2008;52:1071–5. CrossRef
- Yu H, Yang XY, Zhang X, Li Q, Zhu T, Wang Y, Liu B. The effect of dilution and prolonged injection time on fentanyl-induced coughing. Anaesthesia. 2007;62:919–22. CrossRef
- Chen YM, Chen WT, Liang SW, Gu MN. Intravenous injection rate and site of fentanyl affect the incidence and onset time of fentanyl-induced cough. Nan Fang Yi Ke Da Xue Xue Bao. 2009;29:339–40.
- Yakici Ü, Koltka K, Demircan F, Küçükgöncü S, Orhan Sungur M, Karadeniz M, Özkan Seyhan T. The effect of the intravenous injection rate on the incidence of fentanyl induced cough. Anestzi Dergisi. 2013;1:17–22.
- Böhrer H, Fleischer F, Werning P. Tussive effect of a fentanyl bolus administered through a central venous catheter. Anaesthesia. 1990;45:18–21. CrossRef
- Yasuda I, Hirano T, Yusa T, Satoh M. Tracheal constriction by morphine and by fentanyl in man. Anesthesiology. 1978;49:117–9. CrossRef
- Kamei J, Nakanishi Y, Asato M, Ikeda H. Fentanyl enhances the excitability of rapidly adapting receptors to cause cough via the enhancement of histamine release in the airways. Cough. 2013;9:3. CrossRef
- Cheng EY, Mazzeo AJ, Bosnjak ZJ, Coon RL, Kampine JP. Direct relaxant effects of intravenous anesthetics on airway smooth muscle. Anesth Analg. 1996;83:162–8.
- Hung KC. The possible mechanism of clonidine to suppress fentanyl-induced coughing. Acta Anaesthesiol Scand. 2009;53:1227–8.
- Schlimp CJ, Wiedermann FJ. Does fentanyl-induced cough justify pre-treatment with iv lidocaine 2 mg.kg−1. Can J Anaesth. 2005;52:207.
- Poulton TJ, James FM III. Cough suppression by lidocaine. Anesthesiology. 1979;50:470–2. CrossRef
- Kim JY, Chae YJ, Kim JS, Park YJ, Min SK. A target-controlled infusion regimen for reducing remifentanil-induced coughs. Korean J Anesthesiol. 2012;63:30–5. CrossRef
- Terrin N, Schmid CH, Lau J. In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias. J Clin Epidemiol. 2005;58:894–901. CrossRef
- Thornton A, Lee P. Publication bias in meta-analysis: its causes and consequences. J Clin Epidemiol. 2000;53:207–16. CrossRef
- Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis
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- 1. Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
- 2. Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, San 5, Wonchon-dong, Yeongtong-gu, Suwon, 443-721, Korea