Abstract
The purpose of the study was to investigate whether or not the incidence of cough after intra-venous fentanyl depends on the patient’s smoking state and the speed of injection. 530 ASA class I-III patients free of bronchial hyperreactivity and res-piratory tract infection undergoing general anes-thesia for elective surgery were randomized to 1.5 g.kg-1 fentanyl injected over 2, 5 or 10 sec or pla-cebo via a peripheral intravenous cannula. The endpoint was cough within 5 min after completion of injection. Statistical evaluation was performed by factorial ANOVA and chi-square-test. Assuming around 25% smokers in our patient population calculated patient sample size was 340 per group. The study was terminated for futility after enrol-ment of 530 patients since an interims analysis yielded an incidence of cough of 2 % both in smokers (n=174) and nonsmokers (n=356, p= 0,970), which was unrelated to the speed of injec-tion and not different from placebo.
Highlights
Cough after intravenous fentanyl for induction of anesthesia has been overestimated for more than 15 years
We have shown in ASA I-III nonsmoking European patients that the incidence of cough after 1.5 g.kg-1 fentanyl is around 4% and not related to the speed of injection [1], much lower than previously assumed [2,3,4,5,6,7,8,9]
Fentanyl induced cough is believed to be much lower in smokers compared to nonsmokers (3% vs 13%) with the incidence depending on the speed of injection [8]
Summary
Cough after intravenous fentanyl for induction of anesthesia has been overestimated for more than 15 years. We have shown in ASA I-III nonsmoking European patients that the incidence of cough after 1.5 g.kg-1 fentanyl is around 4% and not related to the speed of injection [1], much lower than previously assumed [2,3,4,5,6,7,8,9]. Fentanyl induced cough is believed to be much lower in smokers compared to nonsmokers (3% vs 13%) with the incidence depending on the speed of injection [8]. To evaluate the influence of smoking on the incidence of fentanyl induced cough we performed a single blinded, randomized controlled study with peripheral intravenous injection of 1.5 g.kg-1 bw fentanyl. In addition we hypothesizedd that in smokers the speed of injection is not related to the incidence of cough
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