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Tussive effect of a fentanyl bolus

Canadian Journal of Anaesthesia volume 38, pages 330–334 (1991)Cite this article

Abstract

The aim of this study was to investigate the incidence of pre-induction coughing, after an iv bolus of fentanyl. The study sample was 250 ASA physical status I-II patients, scheduled for various elective surgical procedures. The first 100 were randomly allocated to recieve 1.5 μg · kg−1 fentanyl via a peripheral venous cannula (Group 1), or an equivalent volume of saline (Group 2). Twenty-eight per cent of patients who received fentanyl, but none given saline, coughed within one minute (P < 0.0001). The second 150 patients were then randomly assigned to three equal pretreatment groups. Group 3 received 0.01 μg · kg-1 atropine iv one minute before fentanyl. Groups 4 and 5 received 0.2 μg · kg-1 morphine im, and 7.5 mg midazolam po, respectively, one hour before fentanyl. Thirty per cent of patients in Group 3, 6% in Group 4, and 40% in Group 5, had a cough response to fentanyl. Fentanyl, when given through a peripheral cannula, provoked cough in a considerable proportion of patients. This was not altéréd by prémédication with atropine or midazolam, but was reduced after morphine (P < 0.01). Coughing upon induction of anaesthesia is undesirable in some patients, and stimulation of cough by fentanyl in unpremedicated patients may be of clinical importance.

Résumé

Le but de cette étude était d’investiguer l’incidence de la toux pré-induction après bolus intraveineux de fentanyl. La population de l’étude était de 250 patients ASA I–II cédulés pour des procédures chirurgicales électives variées. Les premiers 100 patients furent randomisés afin de recevoir 1.5 μg · kg−1 de fentanyl à trovers une canule veineuse périphérique (Groupe 1), ou un volume équivalent de salin (Groupe 2). Vingthuit pour cent des patients y ont reçu du fentanyl mais aucun de ceux qui ont reçu du salin, ont toussé a l’intérieur d’une minute (P < 0,0001). Les 150 autres patients furent ensuite randomises en trois groupes égaux de prétraitement. Le groupe 3 a reçu 0,01 μg · kg−1 d’atropine iv une minute avant le fentanyl et le groupe 4 et 5 ont reçu 0,2 mg · kg−1 de morphine im et 7,5 mg de midazolam po, respectivement, une heure avant le fentanyl. Trente pour cent des patients dans le Groupe 3, 6% dans le Groupe 4, et 40% dans le Groupe 5, ont présenté de la toux lors de l’injéction du fentanyl. Le fentanyl, lorsqu’administré dans une canule périphérique, a provoqué de la toux chez un grand nombre de patients. Ceci ne fut pas altéré par la prémédication avec l’atropine ou le midazolam mais fut réduit après morphine (P < 0,01). La toux lors de l’induction de l’anesthésie n’est pas désirée chez certains patients, et la stimulation de la toux par le fentanyl chez des patients nonprémédiqués peut être d’une importance clinique.

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Affiliations

  1. Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, 0511, Singapore

    Wee Thuan Phua, Boon Teck Teh, Winston Jong, Tat Leang Lee & William A. Tweed

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  1. Wee Thuan Phua
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  2. Boon Teck Teh
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  3. Winston Jong
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  4. Tat Leang Lee
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  5. William A. Tweed
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Phua, W.T., Teh, B.T., Jong, W. et al. Tussive effect of a fentanyl bolus. Can J Anaesth 38, 330–334 (1991). https://doi.org/10.1007/BF03007623

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Key words

  • Analgesics: fentanyl
  • Cough