Intravenous lidocaine suppresses fentanyl-induced cough in Children

Agreta Gecaj-Gashi,Zorica Nikolova-Todorova,Musli Gashi,Vlora Ismaili-Jaha

doi:10.1186/1745-9974-9-20

Abstract

ObjectiveFentanyl-induced cough is usually mild and transitory, but it can be undesirable in patients with increased intracranial pressure, open wounds of the eye, dissecting aortic aneurism, pneumothorax, and reactive airway disease. The aim of this study is to evaluate the efficacy of lidocaine in suppressing fentanyl-induced cough in children during induction in general anesthesia.MethodsOne hundred and eighty-six children of both sexes, aged between 4–10 years, ASA physical status I and II, and scheduled for elective surgery, were recruited for the study. Patients with a history of bronchial asthma, obstructive pulmonary disease, or infections of the respiratory tract were excluded. Patients were randomly allocated to three equal groups (n = 62) to receive 1.0 mg/kg lidocaine (Group I), 0.5 mg/kg lidocaine (Group II), or placebo (equal volume of 0.9% saline; Group III). Each was administered over 5 s one minute before intravenous (IV) administration of fentanyl 2−3 μg/kg during induction in general anesthesia. The severity of coughing was graded by counting the number of episodes of cough: mild (1−2), moderate (3−4) or severe (5 or more).ResultsDemographic information was comparable between groups. The most frequent coughing was observed in the placebo group (Group III; 43.5%), of whom 4.8% (three patients) were graded with severe cough. In Group II, 22.6% patients had cough, of which 1.6% (one patient) was graded as severe. In Group I, 16.1% patients had cough, none of whom were graded as severe.ConclusionOur results demonstrate that IV lidocaine can markedly suppress fentanyl-induced cough in children, even in doses as low as 0.5 mg/kg.

Highlights

Opioids are known for their antitussive effect, but often, intravenous administration of fentanyl during the induction of anesthesia paradoxically induces cough [1,2,3,4,5], the exact mechanisms of fentanyl-induced cough still remain unclear
All patients received an oral administration of 0.3 mg/kg of injectable midazolam mixed with a double volume apple juice 30 minutes before separation from parents or IV (1 mg) and atropine (0.02 mg/kg) when IV access was established before the induction of anesthesia
Phua et al reported that 1.5 μg/kg fentanyl given through a peripheral vein elicited cough in 28% of the patients and a similar incidence of cough was observed by Agarwal et al following 2 μg/kg IV fentanyl through the same route over a period of 5 seconds [2,4]

Summary

Introduction

Opioids are known for their antitussive effect, but often, intravenous administration of fentanyl during the induction of anesthesia paradoxically induces cough [1,2,3,4,5], the exact mechanisms of fentanyl-induced cough still remain unclear. Fentanyl is commonly used as a preinduction adjunct in children. Fentanyl-induced cough is quite common and benign, but sometimes it may be explosive and can be associated with an increase in intraocular, intracranial, and intra-abdominal pressures, which may require immediate treatment [3,4,6]. Intravenous administration of lidocaine suppresses the cough reflex during endotracheal intubation, extubation, bronchography, bronchoscopy, and laryngoscopy [7,8,9].

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Results

Conclusion