title: Terbutaline inhalation suppresses fentanyl-induced coughing.
abstract: OBJECTIVE
  To study the suppressive effect of inhalation of a selective beta 2-adrenergic bronchodilator terbutaline, and the effect of an intravenous anticholinergic, atropine, on fentanyl-induced coughing.
  
  
  METHODS
  We studied 131 ASA class I patients, aged 16-45 yr, scheduled for elective surgery, randomized into four groups. Fifteen minutes before bolus fentanyl (5 micrograms.kg-1, iv), patients inhaled either normal saline (4 ml; Group I, n = 30) or terbutaline (5 mg in 2 ml normal saline; Group 2, n = 34) via a jet nebulizer. After inhalation of normal saline, patients in Group 3 (n = 32) received sterile water iv instead of fentanyl. Patients in Group 4 (n = 35) were pretreated with atropine (0.01 mg.kg-1, iv) 10 min before iv fentanyl bolus. The onset, frequency and intensity of cough were observed immediately by an anaesthetist blinded to the study.
  
  
  RESULTS
  The cough frequency was higher in Groups I (43%) and 4 (46%) than in Groups 2 (3%) and 3 (0%) (P < 0.05). The onset time and intensity of cough showed no difference among groups. No truncal rigidity was observed in patients receiving fentanyl bolus iv. The blood pressure, heart rate, and peripheral oxygen saturation did not change in Groups 1, 2, and 3, while patients in Group 4 showed an increase in heart rate (25.5 +/- 15.2%).
  
  
  CONCLUSIONS
  The inhalation of a selective beta 2-adrenergic bronchodilator, terbutaline, effectively inhibited fentanyl-induced cough, whereas atropine, an antimuscarinic vagolytic, had no efficacy. Our results suggest that bronchoconstriction may underlie the mechanism on fentanyl-induced cough.
authors.affiliation: Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan, Republic of China.
authors.forename: P W
authors.initials: PW
authors.lastname: Lui
authors.forename: C H
authors.initials: CH
authors.lastname: Hsing
authors.forename: Y C
authors.initials: YC
authors.lastname: Chu
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003371:Cough / Q000139:chemically induced / Q000517:prevention & control*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013726:Terbutaline / Q000008:administration & dosage*
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists; D000701:Analgesics, Opioid; D001993:Bronchodilator Agents; D013726:Terbutaline; D005283:Fentanyl