Administration of fentanyl via a slow intravenous fluid line compared with rapid bolus alleviates fentanyl-induced cough during general anesthesia induction

Abstract

Objective

Fentanyl-induced cough (FIC) is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoperative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether administering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia.

Methods

A total number of 1200 patients, aged 18–64 years, were enrolled, all of whom were American Society of Anesthesiologists (ASA) grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 μg/kg via direct injection (control group) or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025.

Results

Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction (9.1%, 95% confidence interval (CI): 6.7%–11.4% vs. 55.9%, 95% CI: 51.8%–60.0%, P=0.000), as were the severity grades (P=0.000). There were no statistical differences between the two groups with regard to other adverse reactions (P>0.05).

Conclusions

The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.

概要

目 的

探讨全麻诱导期经静脉输液管 (墨菲氏管) 给药能否减轻芬太尼诱发的呛咳。

创新点

寻找一个简单易行、 安全可靠的方法减轻全麻诱导期芬太尼诱发的呛咳。 与既往芬成尼和呛咳相关的研究相比, 本研究试验组操作不仅简便、 快速, 而且无需额外使用其它药物或设备, 不增加人力成本或病人经济负担。

方 法

择期行全身麻醉手术 1138 例, 所有患者均采用 咪达唑仑—芬太尼—丙泊酚-顺式阿曲库铵—气管插管麻醉, 随机分为静脉输液管缓慢滴注组 (S 组, 573 例) 与经三通快速输注组 (C 组, 565 例), 记录麻醉诱导期两组患者呛咳发生率及严重程度和其它不良反应发生情况。

结 论

静脉输液管缓慢滴注组呛咳发生率及严重程度较快速输注组明显降低, 其它不良反应发生率比较差异无统计学意义。 全麻诱导期经静脉输液管缓慢滴注芬太尼可明显降低该药所致呛咳的发生率, 且该法简单易行、 安全可靠, 值得推广。