Pretreatment with Nalbuphine Prevents Sufentanil-Induced Cough During the Anesthesia Induction: A Randomized Controlled Trial

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Abstract

Background

Sufentanil-induced cough is frequent during the induction of anesthesia. The aim of this research was to assess the influence of pretreatment with nalbuphine on sufentanil-induced cough.

Patients and Methods

A total of 210 American Society of Anesthesiologists (ASA) I–II patients who are 18–70 years old and scheduled for elective surgery were randomly divided into two groups. Group N was pretreated with 0.3 mg/kg nalbuphine at 150 s before induction with sufentanil, and Group C received the same volume of normal saline as the placebo. We assessed the incidence and severity of cough 2 minutes after sufentanil administration. We also recorded the hemodynamic changes and side effects of sufentanil after sufentanil administration.

Results

No patients had cough in group N, and 30 patients had cough in group C (degree of cough: mild 8; moderate 10; severe 12). The incidence and severity of cough in group N were significantly lower than those in group C.

Conclusion

Pretreatment with 0.3 mg/kg nalbuphine significantly suppressed the incidence and intensity of sufentanil-induced cough.

Most cited references 17

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Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl.

Neeta Bose, Sanjay Dhiraj, Sushil Prakash Ambesh … (2003)

Fentanyl, a synthetic opioid, is a popular choice amongst anesthesiologists in the operating room. Preinduction iv fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times may be explosive requiring immediate intervention. We have studied the role of aerosol inhalation of salbutamol, beclomethasone and sodium chromoglycate in preventing fentanyl induced coughing and have compared their efficacy. Two hundred patients aged 18-60 yr, undergoing elective laparoscopic cholecystectomy were randomized into four groups of 50 each. Group I served as control, while Groups II, III and IV received an aerosol inhalation of salbutamol, beclomethasone or sodium chromoglycate 15 min prior to entering the operating room. Following iv fentanyl (2 micro g x kg(-1)) the incidence of cough was recorded and graded as mild (1-2), moderate (3-5) and severe (> 5) depending on the number of coughs observed. Results were analyzed using 'z' and Fischer's Exact test. A P value of /= 0.05). The use of salbutamol, beclomethasone or sodium chromoglycate aerosol 15 min prior to iv fentanyl administration minimizes fentanyl-induced coughing.

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Difficult or impossible ventilation after sufentanil-induced anesthesia is caused primarily by vocal cord closure.

Paul van Helden, Elaine J Abrams, J Horrow … (1997)

Opioid-induced rigidity often makes bag-mask ventilation difficult or impossible during induction of anesthesia. Difficult ventilation may result from chest wall rigidity, upper airway closure, or both. This study further defines the contribution of vocal cord closure to this phenomenon. With institutional review board approval, 30 patients undergoing elective cardiac surgery participated in the study. Morphine (0.1 mg/kg) and scopolamine (6 microg/kg) given intramuscularly provided sedation along with intravenous midazolam as needed. Lidocaine 10% spray provided topical anesthesia of the oropharynx. A fiberoptic bronchoscope positioned in the airway photographed the glottis before induction of anesthesia A second photograph was obtained after induction with 3 microg/kg sufentanil administered during a period of 2 min. A mechanical ventilator provided 10 ml/kg breaths at 10/min via mask and oral airway with jaw thrust. A side-stream spirometer captured objective pulmonary compliance data. Subjective airway compliance was scored. Pancuronium (0.1 mg/kg) provided muscle relaxation. One minute after the muscle relaxant was given, a third photograph was taken and compliance measurements and scores were repeated. Photographs were scored in a random, blinded manner by one investigator. Wilcoxon signed rank tests compared groups, with Bonferroni correction. Differences were considered significant at P < 0.05. Twenty-eight of 30 patients exhibited decreased pulmonary compliance and closed vocal cords after opioid induction. Two patients with neither objective nor subjective changes in pulmonary compliance had open vocal cords after opioid administration. Both subjective and objective compliances increased from severely compromised values after narcotic-induced anesthesia to normal values (P = 0.000002) after patients received a relaxant. Photo scores document open cords before induction, progressing to closed cords after the opioid (P = 0.00002), and opening again after a relaxant was administered (P = 0.00005). Closure of vocal cords is the major cause of difficult ventilation after opioid-induced anesthesia.

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Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough.

Chin-Shuang Lin, Wei-Zen Sun, Wei-Hung Chan … (2015)

The aim of this study was to evaluate the effectiveness of lidocaine, propofol and ephedrine in suppressing fentanyl-induced cough. 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. 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. 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.

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Author and article information

Journal

Journal ID (nlm-ta): Ther Clin Risk Manag

Journal ID (iso-abbrev): Ther Clin Risk Manag

Journal ID (publisher-id): TCRM

Journal ID (pmc): tcriskman

Title: Therapeutics and Clinical Risk Management

Publisher: Dove

ISSN (Print): 1176-6336

ISSN (Electronic): 1178-203X

Publication date (Electronic): 14 April 2020

Publication date Collection: 2020

Volume: 16

Pages: 281-286

Affiliations

[1 ]Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University , Hefei 230022, People’s Republic of China

[2 ]Department of Anesthesiology, Affiliated Anqing Hospital of Anhui Medical University , Anqing 246003, People’s Republic of China

Author notes

Correspondence: Yao Lu Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University Tel +86 55162922057 Email luyao-mz@163.com

[*]

These authors contributed equally to this work

Article

Publisher ID: 247437

DOI: 10.2147/TCRM.S247437

PMC ID: 7166053

PubMed ID: 32341646

SO-VID: c15e7ff2-d6fd-47e2-80d5-b36ba5055430

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 28 January 2020

Date accepted : 27 March 2020

Page count

Figures: 2, Tables: 2, References: 17, Pages: 6

Funding

This work is supported by the National Natural Science Foundation of China (No. 81770295).

Pretreatment with Nalbuphine Prevents Sufentanil-Induced Cough During the Anesthesia Induction: A Randomized Controlled Trial

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Abstract

Background

Patients and Methods

Results

Conclusion

Most cited references 17

Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl.

Difficult or impossible ventilation after sufentanil-induced anesthesia is caused primarily by vocal cord closure.

Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough.

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Affiliations

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Article

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