Comparison of lidocaine, huffing maneuver and combination of both in prevention fentanyl induced cough before induction of anesthesia: a double-blind, prospective, randomized placebo-controlled study

Laleh Dehghanpisheh,Pooya Vatankhah,Mohammadhossein Eghbal,Fatemeh Bagheri Baravati

doi:10.1186/s12871-021-01313-w

Laleh Dehghanpisheh, Pooya Vatankhah + Show 2 more

Open Access

https://doi.org/10.1186/s12871-021-01313-w

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Journal: BMC anesthesiology	Publication Date: Mar 27, 2021
Citations: 1	License type: open-access

Affiliation: Shiraz University of Medical Sciences

Abstract

BackgroundIntravenous bolus injection of fentanyl has been frequently reported to be associated with cough reflex during patient anesthesia. However, the search for the most effective protocol continues. This study aimed to compare the effect of reducing cough reflex after injection of fentanyl in a fusion protocol by combining the injections of lidocaine and Huffing maneuver and comparing with a placebo control group, before anesthesia induction.MethodsThis prospective randomized controlled trial study was performed on 400 patients who were divided into four groups of combined protocol (group 1), lidocaine group (group 2), Huffing maneuver group (group 3), and the control receiving normal saline (group 4). Then patients were injected with 2. 5 μg /kg fentanyl and monitored for 2 min regarding their cough reflex, as well as the severity.ResultsIn group one, 9 patients (9%), in group two, 45 patients (45%), 22 patients (22%) in group three, and in group four, 75 patients (75%), developed cough reflex following fentanyl injection. Also, 13 patients (13%) developed moderate and 4 (4%) developed severe coughs in the control group reported, while no reports of severe or moderate cough were among the intervention groups. There was a significant difference between the intervention group and the control group both in terms of the rate and severity of the fentanyl-induced cough.ConclusionBy using a combination of lidocaine injection along and Huffing maneuver, better results can be obtained in reducing the frequency, and also the severity of cough followed by fentanyl injection.Trial registrationThe trial was registered with IRCT.IR (09/03/2018-No. IRCT20141009019470N74).

Highlights

Fentanyl-induced cough (FIC) is amongst the most common complications of anesthesia induction by intravenous bolus administration of fentanyl, which has been reported in 18 to 65% of patients [1, 2]
Central sympathetic outflow could be blocked by fentanyl, stimulating the vagus nerve. This vagal activity change has been identified as a potential cause of cough and reflex bronchoconstriction [5, 6]; a study by Lui Ping-Wing et al [5] reported that cough reflex after opioid injection is not likely to be vagally mediated because atropine pretreatment does not affect it
We aimed to evaluate the incidence of FIC, along with its severity after lidocaine injection, Huffing maneuver and a combination of both in order to provide guidelines for anesthesiologists worldwide

Summary

Introduction

Fentanyl-induced cough (FIC) is amongst the most common complications of anesthesia induction by intravenous bolus administration of fentanyl, which has been reported in 18 to 65% of patients [1, 2]. This phenomenon is usually brief and self-limiting, during anesthesia induction, coughing is undesirable since it is associated with increased intracranial (ICP), intraocular, and intra-abdominal pressures. This study aimed to compare the effect of reducing cough reflex after injection of fentanyl in a fusion protocol by combining the injections of lidocaine and Huffing maneuver and comparing with a placebo control group, before anesthesia induction

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Results

Conclusion