Abstract
BackgroundTo investigate the optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough (FIC) suppression.MethodsPatients of 180 undergoing elective surgery with general anesthesia, aged 18–65 years, BMI 18.5–30 kg/m2, ASA I or II, were equally randomized into four groups (n = 45) to receive intravenous pretreatment of dexmedetomidine with 0 (group 1), 0.3 (group 2), 0.6 (group 3) and 0.9 (group 4) mcg/kg over 10 mins, respectively. After the pretreatment, all patients were given a 5-s intravenous injection of fentanyl 4 mcg/kg. The symptoms of irritating cough including the severity and onset time were recorded for 1 min after fentanyl injection. General anesthesia induction was completed with midazolam, propofol and cisatracurium, then endotracheal tube or laryngeal mask was inserted and connected to an anesthesia machine. MAP, HR and SpO2 at the beginning of pretreatment (T0), 3 min (T1), 6 min (T2), 9 min (T3) and 12 min (T4) after the beginning of pretreatment were recorded. Side effects of dexmedetomidine, such as bradycardia, hypertension, hypotension, and respiratory depression were also recorded during the course.ResultsTotally 168 patients completed the study. The incidences of cough were 52.4, 42.9, 11.9, and 14.3% in groups 1, 2, 3, and 4, respectively, with no significant differences between groups 1 and 2 (P > 0.05) and between groups 3 and 4 (P > 0.05). The incidence and severity of cough in groups 3 and 4 were significantly lower than those in groups 1 and 2 (P < 0.05). Compared to T0, HR at T2 (P < 0.05), T3 (P < 0.01), and T4 (P < 0.01) decreased significantly and MAP at T4 decreased significantly (P < 0.05) in group 4. Bradycardia occurred in 1 case and respiratory depression occurred in 1 case in group 4. Compared to group 1, the onset time of cough in the other 3 groups were delayed significantly (P < 0.05).ConclusionPretreated dexmedetomidine 0.6 mcg/kg blous intravenous infusion over 10 mins could reduce FIC effectively without side effects.Trial registrationThis study was registered in ClinicalTrials.gov (NCT03126422), April 13, 2017.
Highlights
To investigate the optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough (FIC) suppression
There were no significant differences among the four groups with respect to demographic data including age, sex, Body mass index (BMI), and ASA physical status (P > 0.05) (Table 1)
The present study discovered that pretreatment with dexmedetomidine intravenous infusion of 0.6 mcg/kg bolus given over 10 mins reduced the severity of FIC effectively without adverse effects when fentanyl 4 mcg/kg was injected with the injection time of 5 s
Summary
To investigate the optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough (FIC) suppression. The incidence of fentanyl-induced cough (FIC) can reach 80% [2]. The FIC may be transitory and limited; it can be explosive and detrimental especially in patients with increased intracranial, intraocular, intrathoracic, or intraabdominal pressure [3,4,5]. FIC could even cause severe upper airway obstruction and aspiration pneumonia that require immediate intervention [6, 7]. A report that explosive FIC produced multiple conjunctival and periorbital petechiae has been published [8]. FIC needs immediate and effective intervention especially in patients with cerebral aneurysm, brain trauma, hernia, open eye injury, dissecting aortic aneurysm, pneumothorax or hypersensitive airway disease.
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