A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial

Wendong Lin,Jiehao Sun,Shuying Fu

doi:10.1186/s12871-019-0836-1

Abstract

BackgroundIntravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia.MethodsThis prospective, randomized, controlled trial was conducted from January 10, 2019 to March 01, 2019. A total of 100 patients undergoing elective surgery under general anesthesia were enrolled, and at last 84 patients were included and randomly allocated into two equal size groups (n = 42): Patients in the Remifentanil group (R group) received an intravenous infusion of remifentanil 0.3 μg/kg (diluted to 2 ml) 1 min before sufentanil injection; patients in the Control group (C group) received 2 ml of normal saline (NS) at the same time point. Injections of patients in both groups were completed within 5 s. Then, sufentanil 0.5 μg/kg was injected within 5 s and the number of coughs that occurred within 1 min after sufentanil injection were recorded. One minute after sufentanil injection, etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were given for general anesthesia induction irrespective of the presence or absence of cough. The mean arterial pressure (MAP) and heart rate (HR) at time points just before remifentanil pretreatment administration (T0), 3 min after administration (T1), 1 min after intubation (T2), and 3 min after intubation (T3) were recorded.ResultsThe incidence of cough in patients in the R group and C group was 4.8 and 31%, respectively. Compared with group C, the incidence and severity of cough in group R was significantly lower (P < 0.01). No significant differences were observed in MAP and HR at the time of general anesthesia induction between the two groups (P > 0.05).ConclusionPretreatment with a small dose of remifentanil effectively and safely reduced the incidence and severity of cough induced by sufentanil during anesthesia induction and can be used as an alternative treatment to inhibit coughing caused by sufentanil.Trial registrationChinese Clinical Trial Registry (ChiCTR1900020587, registered date: January 9, 2019), http://www.chictr.org.cn

Highlights

Intravenous use of sufentanil can elicit cough
In this study, we evaluated the effects of remifentanil on the incidence and severity of sufentanil-induced cough during the induction of general anesthesia, thereby aiming to assess whether a small dose of remifentanil could be used as an treatment to inhibit sufentanil-induced cough
A total of 100 eligible patients were screened among which 84 patients participated in our study and were included in the final analyses (Fig. 1)

Summary

Introduction

Intravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia. Various agents have been used for cough suppression prior to induction of general anesthesia including: 1intravenous opioid such as fentanyl, 2- intramuscular morphine, 3-dexmedetomidine, 4- magnesium sulfate, 5terbutaline, 6- lidocaine, and 7- dezocine [1, 3,4,5,6,7,8]. Because of their more or less potential additional side effects, long onset time, long duration, inconvenience to get, they were somewhat limited in clinical use.

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