title: Pre-emptive oral dexmethorphan reduces fentanyl-induced cough as well as immediate postoperative adrenocortico-tropic hormone and growth hormone level.
abstract: BACKGROUND
  Fentanyl-induced cough is not always benign and brief and can be remarkably troublesome, spasmodic, and explosive. Dextromethorphan, an opioid derivative with an antitussive action, may be effective in reducing the fentanyl-induced cough. Dextromethorphan, a N-methyl D aspartate receptor antagonist, may have some effect on diminishing the stress response to surgery. This study was undertaken to determine whether preoperative dextromethorphan could effectively attenuate its incidence, severity, and effect on postoperative stress hormone levels.
  
  
  METHODS
  Three hundred and twenty patients of American society of anesthesiologists I-II, aged 18-60 years, undergoing elective laparoscopic cholecystectomy or appendicectomy were randomly allocated into two groups (Group C, control; Group D, dextromethorphan) consisting of 160 patients each. Patients in Group D received dextromethorphan 40 mg orally and in Group C received placebo tablets 60 minutes before induction of anesthesia. The incidence of cough was recorded for 1 minute after fentanyl injection and graded as none (0), mild (1-2), moderate (3-5), and severe (>5 cough). Blood samples were collected for estimation of stress hormone levels before surgery and again at 1 hour and 24 hours postoperatively and compared. The appearance of adverse reactions was recorded.
  
  
  RESULTS
  The incidence of reflex fentanyl cough was lower in dextromethorphan group (3.9%) in comparison to placebo (59.8%). Five patients developed mild and one moderate cough in the dextromethorphan group. In the control group, 31 patients developed mild, 29 moderate, and 32 severe cough. The stress hormones were significantly higher at 1 hour and 24 hours postoperatively in both groups in comparison to its preoperative values. However, at 1 hour postoperatively, adrenocorticotropic hormone, epinephrine, and growth hormone values were significantly low in the dextromethorphan group (61.5 ± 21.1 pg/ ml, 142.1 ± 11.2 pg/ml, and 3.8 ± 0.7 ng/ml) relative to the control group (73.4 ± 21.9 pg/ml, 158.9 ± 17.9 pg/ml, and 4.2 ± 1.3 ng/ml), but changes became insignificant at 24 hours postoperatively.
  
  
  CONCLUSIONS
  Preoperative oral dextromethorphan 40 mg decreased the incidence and severity of fentanyl induced cough and reduced the rise in stress hormones at 1 hour postoperatively.
authors.affiliation: Department of Anaesthesiology, R.G. Kar Medical College, Kolkata, India.
authors.forename: Avik
authors.initials: A
authors.lastname: Mukherjee
authors.forename: Asim Kumar
authors.initials: AK
authors.lastname: Kundu
authors.forename: Sudipta
authors.initials: S
authors.lastname: Ghosh
authors.forename: Rajat
authors.initials: R
authors.lastname: Choudhuri
authors.forename: Bijoy Kumar
authors.initials: BK
authors.lastname: Bandopadhyay
authors.forename: Sugata
authors.initials: S
authors.lastname: Dasgupta
references.citation: Can J Anaesth. 2003 Mar;50(3):297-300
references.pmid: 12620955
references.citation: Br J Anaesth. 2010 Jan;104(1):40-3
references.pmid: 19933512
references.citation: Acta Anaesthesiol Scand. 2007 Aug;51(7):862-5
references.pmid: 17578464
references.citation: Anesthesiology. 1978 Aug;49(2):117-9
references.pmid: 686415
references.citation: Anaesthesia. 2007 Sep;62(9):919-22
references.pmid: 17697219
references.citation: Eur J Pharmacol. 1998 Jun 5;350(2-3):259-65
references.pmid: 9696416
references.citation: Anesthesiology. 1986 Apr;64(4):440-6
references.pmid: 3008595
references.citation: Anesth Analg. 2004 Mar;98(3):714-22, table of contents
references.pmid: 14980926
references.citation: J Neurosurg Anesthesiol. 2008 Oct;20(4):241-8
references.pmid: 18812887
references.citation: Anesth Analg. 2001 Jun;92(6):1442-3
references.pmid: 11375822
references.citation: Acta Anaesthesiol Scand. 2005 Nov;49(10):1520-6
references.pmid: 16223400
references.citation: Psychopharmacology (Berl). 2004 Nov;176(3-4):398-406
references.pmid: 15114434
references.citation: Anesth Analg. 2005 Sep;101(3):670-674
references.pmid: 16115973
references.citation: Anesth Analg. 2001 Mar;92(3):739-44
references.pmid: 11226111
references.citation: Anesth Analg. 2005 Dec;101(6):1700-1705
references.pmid: 16301244
references.citation: Neuropsychopharmacology. 2001 May;24(5):590-3
references.pmid: 11282259
references.citation: J Clin Anesth. 2007 Feb;19(1):53-6
references.pmid: 17321928
references.citation: Can J Anaesth. 1996 Dec;43(12):1216-9
references.pmid: 8955969
references.citation: Anesth Analg. 2004 May;98(5):1385-400, table of contents
references.pmid: 15105220
references.citation: J Physiol. 1969 Aug;203(3):511-32
references.pmid: 5387024
references.citation: J Formos Med Assoc. 2007 Aug;106(8):649-55
references.pmid: 17711798
references.citation: Can J Anaesth. 2006 Aug;53(8):753-8
references.pmid: 16873340
references.citation: Pharmacol Rep. 2010 Jul-Aug;62(4):747-50
references.pmid: 20885016
references.citation: J Reprod Dev. 2007 Jun;53(3):545-54
references.pmid: 17272925
references.citation: Br J Anaesth. 1981 Feb;53(2):153-60
references.pmid: 7008816
references.citation: Br J Anaesth. 2009 Oct;103(4):484-9
references.pmid: 19617379
references.citation: Can J Anaesth. 2004 Aug-Sep;51(7):654-9
references.pmid: 15310631
references.citation: Neuroendocrinology. 1999 May;69(5):316-23
references.pmid: 10343172