Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough.
OBJECTIVE
The aim of this study was to evaluate the effectiveness of lidocaine, propofol and ephedrine in suppressing fentanyl-induced cough.


METHODS
One hundred and eighteen patients were randomly assigned into four groups and the following medications were given intravenously: patients in Group I (n = 31) received normal saline 2 mL, Group II (n = 29) received lidocaine 2 mg.kg(-1), Group III (n = 30) received propofol 0.6 mg.kg(-1) and Group IV (n = 28) received ephedrine 5 mg. At one minute after the study medication, fentanyl 2.5 microg.kg(-1) was given intravenously within two seconds. The occurrence of cough and vital sign profiles were recorded within two minutes after fentanyl bolus by an anesthesiologist blinded to study design.


RESULTS
Sixty-five percent of patients in the placebo group had cough, whereas the frequency was significantly decreased in Groups II (14%) and IV (21%). Although a numerically lower frequency of cough was noted in Group III (37%), it was not statistically different from that of the placebo group. SpO(2) decreased significantly in patients of Group III compared to placebo; one patient experienced hypoxemia necessitating mask ventilation. Patients in Group III showed a decrease in heart rate and systolic blood pressure (2 beats.min(-1) and 8 mmHg vs baseline). Patients in Group IV showed an increase in both measurements (5 beats.min(-1) and 8 mmHg vs baseline). No truncal rigidity was observed throughout the study.


CONCLUSIONS
Intravenous lidocaine 2 mg.kg(-1) or ephedrine 5 mg, but not propofol 0.6 mg.kg(-1), was effective in preventing fentanyl-induced cough. The results provide a convenient method to decrease fentanyl-induced cough.
Lin
Chin-Shuang
CS
Department of Anesthesiology, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan 100.
Sun
Wei-Zen
WZ
Chan
Wei-Hung
WH
Lin
Chen-Jung
CJ
Yeh
Huei-Ming
HM
Mok
Martin S
MS
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000494:pharmacology; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D003371:Cough / Q000139:chemically induced* / Q000188:drug therapy*; D004809:Ephedrine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D008297:Male; D010100:Oxygen / Q000097:blood; D015742:Propofol / Q000009:adverse effects / Q000494:pharmacology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001993:Bronchodilator Agents; D008012:Lidocaine; D004809:Ephedrine; D010100:Oxygen; D005283:Fentanyl; D015742:Propofol