Abstract
Purpose
To determine how the probability of fentanyl-induced cough is affected by patient characteristics and/or anesthetic technique.
Methods
We analyzed data from a cohort of 1,311 adult patients undergoing elective surgery under general anesthesia, accompanied byiv fentanyl. The following data were collected: patient demographics, history of cigarette smoking, presence of bronchial asthma or chronic obstructive pulmonary disease, administration of angiotensin converting enzyme inhibitors; and anesthetic technique, including: preanesthetic anxiolytic medication, prior use of atropine, epidural lidocaine, a priming dose of vecuronium, and the dose ofiv fentanyl. Associations between individual variables in the clinical evaluation model and the likelihood of fentanyl-induced cough were characterized by calculating odds ratios. Multiple logistic regression analysis was used to examine the independent contribution of each variable while controlling for all variables.
Results
Fentanyl-induced cough was independently associated with the following: aging, cigarette smoking, a prior epidural injection of lidocaine, and a priming dose of vecuronium. Fentanyl-induced cough was unaffected by gender, the presence of either bronchial asthma or chronic obstructive pulmonary disease, or prior use of atropine.
Conclusions
Fentanyl-induced cough may be suppressed by aging, cigarette smoking, prior epidural injection of lidocaine, or a priming dose of vecuronium. These findings may allow insights into the mechanism of this phenomenon, thereby leading to its prevention.
Résumé
Objectif
Déterminer comment la probabilité de toux induite par le fentanyl est modifiée par les caractéristiques du patient et/ou la technique anesthésique.
Méthode
Nous avons analysé les données sur 1 311 patients adultes qui ont subi une opération réglée sous anesthésie générale accompagnée de fentanyl iv. Nous avons noté les données suivantes: les caractéristiques des patients, les antécédents de tabagisme, la présence d’asthme bronchique ou de maladie pulmonaire obstructive chronique, l’administration d’inhibiteurs de l’enzyme de conversion de l’angiotensine. La technique anesthésique comprenait: la médication préanesthésique anxiolytique, l’usage antérieur d’atropine, l’anesthésie péridurale avec lidocaïne, la dose d’amorçage de vécuronium et la dose iv de fentanyl. Les associations entre les variables individuelles dans le modèle d’évaluation clinique et la probabilité de toux induite par le fentanyl ont été définies par le calcul du risque relatif. Une analyse de régression logistique multifactorielle a servi à vérifier la contribution indépendante de chaque variable tout en contrôlant pour toutes les variables.
Résultats
La toux induite par le fentanyl a été indépendamment associée aux données suivantes: l’âge, le tabagisme, une injection péridurale antérieure de lidocaïne et une dose d’amorçage de vécuronium. La toux induite par le fentanyl n’était pas modifiée par le sexe du patient, l’asthme bronchique ou la maladie pulmonaire obstructive chronique ou l’usage antérieure d’atropine.
Conclusion
La toux induite par le fentanyl peut être supprimée par le vieillissement, le tabagisme, une injection péridurale antérieure de lidocaïne ou une dose d’amorçage de vécuronium. Ces résultats peuvent donner un aperçu du mécanisme de ce phénomène et conduire à sa prévention.
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This study was supported in part by Grant-in-Aid 17591624 from Japan Society for the Promotion of Science.
Competing interests: None declared.
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Oshima, T., Kasuya, Y., Okumura, Y. et al. Identification of independent risk factors for fentanyl-induced cough. Can J Anesth 53, 753–758 (2006). https://doi.org/10.1007/BF03022790
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DOI: https://doi.org/10.1007/BF03022790