Comparison of the effects of pretreatment intravenous fentanyl or intravenous lidocaine on suppression of fentanyl-induced cough in children

a randomized, double-blind, controlled clinical trial

Authors

  • Mitra Golmohammadi MD., Anesthesiologist, Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background and aim: The injection of fentanyl usually causes coughing during induction of anesthesia. Based on a few studies about effects of lidocaine and the fact there is no study concerning the effect of fentanyl on fentanyl-induced cough in pediatric patients, the aim of this study was to compare the effectiveness of low dose of fentanyl with lidocaine in prevention of fentanyl-induced cough in children. Methods: This randomized double-blind controlled clinical trial study was conducted at Motahari Hospital between February and August 2017 in Urmia (Iran). One hundred patients, aged 2-10 years, of class I or II ASA status who were candidates for elective herniorrhaphy under general anesthesia were enrolled in this study. They were randomly divided into three groups. One minute before the administration of 2 μg/kg fentanyl during induction of general anesthesia, Group I received 1.0 mg/kg lidocaine (n=33), Group II received 0.5 μg/kg fentanyl (n=34) and Group III received normal saline as a control group (n=33). The data were analyzed by STAT version 13. The incidence and severity of cough were determined across groups by using ANOVA and Chi-square tests. Multiple logistic regression was also used to examine the association between the outcome of cough incidence and clinical interventions as the exposures after adjusting for study covariates. Results: The highest incidence of cough was found in the Group III (54.5%) versus 32.4% and 21.1% in Group II and Group I subsequently (p=0.02). We have also found significant difference in the incidence of cough among group one and three (p=0.005), and among group two and three (p=0.045). No statistically significant difference has been detected between group one and two. The severity of cough was significantly higher in Group III compared to Groups I and II (p=0.01).The time of onset of cough was similar across groups. No side effects were reported after intervention in this study Conclusion: This study found that pretreatment with fentanyl 0.5mg/kg or 1mg/kg lidocaine is an effective approach to reducing the incidence and severity of fentanyl-induced cough in children.  Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://WWW.irct.ir) with IRCT number: IRCT2016112027677N5. Funding: This study was not granted or funded by any institution.

References

Miller DR, Cohen NH, Erikson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia.

; 31,94 :877-8,2769.

Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to

endotracheal intubation more than the response to laryngoscopy. Anesth Analg. 2002; 95: 233-7. doi:

1097/00000539-200207000-00043. PMID: 12088976.

Bohrer H, Fleischer F, Werning P. Tussive effect of a fentanyl bolus administered through a central venous

catheter. Anaesthesia. 1990; 45: 18–21. doi: 10.1111/j.1365-2044.1990.tb14496.x. PMID: 2316832.

Tweed WA, Dakin D. Explosive coughing after fentanyl injection. Anesth Analg. 2001; 92: 1442–5. doi:

1097/00000539-200106000-00018. PMID: 11375822.

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:

Han JI, Lee H, Kim CH, Lee GY. The frequency of fentanyl-induced cough in children and its effects on

tracheal intubation. J Clin Anesth. 2010; 22: 3-6. PMID: 20206844. doi: 10.1016/j.jclinane.2009.01.019.

Oshima T, Kasuya Y, Okumura Y, Murakami T, Dohi S. Identification of independent risk factors for

fentanyl-induced cough. Can J Anaesth. 2006; 53: 753-8. doi: 10.1007/BF03022790. PMID: 16873340.

Yu H, Yang XY, Zhang X, Li Q, Zhu T, Wang Y, et al. The effect of dilution and prolonged injection time

on fentanyl-induced coughing. Anaesthesia. 2007; 62: 919-22. doi: 10.1111/j.1365-2044.2007.05147.x.

PMID: 17697219.

Gecaj-Gashi A, Nikolova-Todorova Z, Ismaili-Jaha V, Gashi M. Intravenous lidocaine suppresses fentanylinduced cough in Children. Cough. 2013; 9: 20. doi: 10.1186/1745-9974-9-20. PMID: 23947795, PMCID:

PMC3751768.

Kim DH, Yoo JY, Moon BK, Yoon BH, Kim JY. The effect of injection speed on remifentanil-induced

cough in children. Korean J Anesthesiol. 2014; 67(3): 171-4. doi: 10.4097/kjae.2014.67.3.171. PMID:

, PMCID: PMC4188761.

Baraka A. IV lidocaine controls extubation laryngospasm in children. Anesth Analg. 1978; 57: 506–7. doi:

1213/00000539-197807000-00028. PMID: 360878.

Gu C, Zhou M, Wu H, Li E, Tang C. Effects of different priming doses of fentanyl on fentanyl-induced

cough: A double-blind randomized controlled study. Pharmacol Rep. 2012; 64(2): 321-5. PMID:

Du BX, Cao L, Zhao WL, Xu ZH, Song J, Shi XY. Pre-emptive small dose of fentanyl suppresses fentanylinduced cough: a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2014; 7(4): 826-36.

PMID: 24955151, PMCID: PMC4057830.

Lui PW, Hsing CH, Chu YC. Terbutaline inhalation suppresses fentanyl induced coughing. Can J Anaesth

; 43: 1216–9. doi: 10.1007/BF03013427. PMID: 8955969.

Poulton TJ, James FR. Cough suppression by lidocaine. Anes- thesiology. 1979; 50: 470–2. PMID:

Fuller Rv, Jackson DM. Physiology and treatment of cough. Thorax. 1990; 45: 425-30. PMID: 2203180,

PMCID: PMC462522.

Young EC, Smith JA. Pharmacologic therapy for cough. Curr Opin Pharmacol. 2011; 11(3): 224-30.

PMID: 21724464. doi: 10.1016/j.coph.2011.06.003.

Yasuda I, Hirano T, Yusa T, Satoh M. Tracheal constriction by morphine and by fentanyl in man.

Anesthesiology. 1978; 49: 117–9. PMID: 686415.

Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D, et al. Salbutamol, beclomethasone or so- dium

chromoglycate suppress coughing induced by iv fentanyl. Can J Anaesth. 2003; 50: 297–300. PMID:

doi: 10.1007/BF03017801.

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. doi: 10.1007/BF03018421.

PMID: 15310631.

Benthuysen JL, Smith NT, Sanford TJ, Head N, Dec-Silver H. Physiology of alfentanil-induced rigidity.

Anesthesiology.1986; 64: 440–6. PMID: 3008595.

Pontoppidan H, Beecher HK. Progressive loss of protective reflexes in the airway with the advance of age.

JAMA. 1960; 174: 2209-13. doi: 10.1001/jama.1960.03030180029007. PMID: 13737040.

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.

Int Med Res. 2011; 39(6): 2379-84. doi: 10.1177/147323001103900638. PMID: 22289557.

Honarmand A, Safavi M, Khalighinejad F. A comparison of the effect of pretreatment with intravenous

dexamethasone, intravenous ketamine, and their combination, for suppression of remifentanil-induced

cough: A randomized, double-blind, placebo-controlled clinical trial. Adv Biomed Res. 2013; 2: 60. doi:

4103/2277-9175.115808. PMID: 24223375, PMCID: PMC3814903.

Published

2021-12-24

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