Identification of independent risk factors for fentanyl-induced cough.
OBJECTIVE
To determine how the probability of fentanyl-induced cough is affected by patient characteristics and/or anesthetic technique.


METHODS
We analyzed data from a cohort of 1,311 adult patients undergoing elective surgery under general anesthesia, accompanied by i.v. fentanyl. The following data were collected: patient demographics, history of cigarette smoking, presence of bronchial asthma or chronic obstructive pulmonary disease, administration of angiotensin converting enzyme inhibitors; and anesthetic technique, including: preanesthetic anxiolytic medication, prior use of atropine, epidural lidocaine, a priming dose of vecuronium, and the dose of i.v. fentanyl. Associations between individual variables in the clinical evaluation model and the likelihood of fentanyl-induced cough were characterized by calculating odds ratios. Multiple logistic regression analysis was used to examine the independent contribution of each variable while controlling for all variables.


RESULTS
Fentanyl-induced cough was independently associated with the following: aging, cigarette smoking, a prior epidural injection of lidocaine, and a priming dose of vecuronium. Fentanyl-induced cough was unaffected by gender, the presence of either bronchial asthma or chronic obstructive pulmonary disease, or prior use of atropine.


CONCLUSIONS
Fentanyl-induced cough may be suppressed by aging, cigarette smoking, prior epidural injection of lidocaine, or a priming dose of vecuronium. These findings may allow insights into the mechanism of this phenomenon, thereby leading to its prevention.
Oshima
Tsutomu
T
Department of Anesthesia, Gifu University School of Medicine, Gifu-City, Japan. oshimat@med.teikyo-u.ac.jp
Kasuya
Yoshiko
Y
Okumura
Yasuhisa
Y
Murakami
Tatsuo
T
Dohi
Shuji
S
D000328:Adult; D000367:Age Factors; D000767:Anesthesia, Epidural; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001249:Asthma / Q000503:physiopathology; D001285:Atropine / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003371:Cough / Q000139:chemically induced*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D011229:Preanesthetic Medication; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology; D012307:Risk Factors; D012907:Smoking / Q000503:physiopathology; D014673:Vecuronium Bromide / Q000008:administration & dosage
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D000806:Angiotensin-Converting Enzyme Inhibitors; D014151:Anti-Anxiety Agents; D001993:Bronchodilator Agents; D003473:Neuromuscular Nondepolarizing Agents; D001285:Atropine; D014673:Vecuronium Bromide; D008012:Lidocaine; D005283:Fentanyl