Abstract
Objective:Fentanyl is frequently used during anesthesia induction. The use of fentanyl can cause cough through different mechanisms. Here, we aimed to investigate effects of pheniramine maleate (PM), an antihistaminic agent, and compare it with lidocaine on fentanyl induced cough.Methods:This is a randomized double-blind prospective clinical study of ASA I-II, 120 patients scheduled for elective abdominal surgery. Patients were administered drugs intravenously and randomly allocated into three groups: Group C (2 ml 0.9 % normal saline), Group L (1mg/kg lidocaine), and Group F (PM 45.5 mg). 90 seconds after administration, 2µ/kg fentanyl was applied in three seconds to all patients. Severity of cough (mild: 1-2, moderate: 3-5, severe> 5), time of the cough and vital parameters were recorded 90 seconds after fentanyl injection.Results:Eight patients (25%) in Group C had fentanyl induced cough whereas three patients (7.5%) in Group L and one patient (2.5%) in Group F experienced this phenomenon. There was statistically significant difference between Group F and Group C (p<0.05); however, differences between Group L and Group C or Group F and Group L were not statistically significant (p>0.05).Conclusions:Pheniramine Maleate 45.5 mg is better that placebo and as effective as lidocaine to prevent fentanyl induced cough.
Highlights
Number of patients who had fentanyl induced cough, distribution among groups and severity of the cough are shown in Table-II
There was no statistical difference between Group L and Group C or Group F and Group L (p=0.193 and p=0.615 respectively) by means of cough frequency
Fentanyl use can cause histamine release and bronchospasm especially in children with allergy history; this may in return can cause difficulty in ventilation.[14]
Summary
Fentanyl is a frequently used synthetic opioid agent in anesthesia induction due to its high analgesic efficacy, fast onset of effect, reducing effect on cardiovascular response.[1,2] Despite opioid agonists have antitussive effects; fentanyl, is an an opioid which can cause cough if administered as bolus intravenously during anesthesia induction.[3,4] Cough during general anesthesia induction can cause several adverse effects requiring immediate action because of increased intracranial, intraocular and intra-abdominal pressures.[5,6] Supraglottic obstruction by soft tissue, fentanyl induced histamine release and/or sudden adduction in vocal cord muscles due to opioid induced muscle rigidity may be the mechanism of opioid induced cough.[7,8]In addition, smoking leads to respiratory symptoms, such as cough, increased mucus secretion, and airway inflammation. Fentanyl is a frequently used synthetic opioid agent in anesthesia induction due to its high analgesic efficacy, fast onset of effect, reducing effect on cardiovascular response.[1,2] Despite opioid agonists have antitussive effects; fentanyl, is an an opioid which can cause cough if administered as bolus intravenously during anesthesia induction.[3,4] Cough during general anesthesia induction can cause several adverse effects requiring immediate action because of increased intracranial, intraocular and intra-abdominal pressures.[5,6] Supraglottic obstruction by soft tissue, fentanyl induced histamine release and/or sudden adduction in vocal cord muscles due to opioid induced muscle rigidity may be the mechanism of opioid induced cough.[7,8]. In our routine anesthesia management, the incidence of fentanylinduced cough does not seem to be more frequent in current smokers, contradicting expectations regarding the impact of smoking on cough. Studies on fentanyl-induced cough have generally excluded smokers from analysis and the effects of smoking was evaluated in a few studies. There are many studies regarding incidence of fentanyl induced cough and have different results. Several methods are tried to prevent fentanyl induced cough.[3,4,11,12,13] But, in literature there is no data about the effect of pheniramine maleat on fentanyl induced cough
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