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Gao L, Zhang Z, Zhu Y, Lu X, Tian Y, Wei L. Effect of pretreatment with a small dose of esketamine on sufentanil-induced cough during anesthesia induction: a randomized controlled trial. BMC Anesthesiol 2024; 24:116. [PMID: 38528479 PMCID: PMC10964693 DOI: 10.1186/s12871-024-02501-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Sufentanil-induced cough is common during the induction of anesthesia. The objective of this study was to determine whether pretreatment with a small dose of esketamine is effective in treating sufentanil-induced cough. METHODS 220 patients were screened, and 200 patients who had scheduled elective surgery and were between 18 and 70 years old were randomly divided into two groups. Before sufentanil was administered, esketamine group (group K) was injected with 0.15 mg/kg esketamine at 5 s, and control group (group C) was administered with the same volume. Within 1 min after sufentanil(0.4ug/kg) injection during induction, cough incidence and severity were evaluated. After sufentanil was injected, we recorded its hemodynamic changes and side effects. RESULTS In the esketamine group (group K) and control group (group C), there was an incidence of cough of 5 and 34%, respectively. The esketamine group (group K) had a significantly lower incidence and severity of cough compared to the control group (group C) immediately after sufentanil injection (P < 0.05). MAP and HR did not differ significantly between the two groups during three different times of general anesthesia induction (P > 0.05). CONCLUSION In our study, we found that sufentanil-induced cough was significantly reduced by pretreatment with 0.15 mg/kg esketamine, but with no significant changes in the hemodynamic status. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2200063821, registered date: 17/09/2022), http://www.chictr.org.cn.
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Affiliation(s)
- Liangliang Gao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221000, China
| | - Zhuoliang Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221000, China
| | - Yi Zhu
- Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, 215000, China
| | - Xinyu Lu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221000, China
| | - Yue Tian
- Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, 215000, China
| | - Lei Wei
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221000, China.
- Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou, 215000, China.
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Wang L, Lu X, Cheng Y, Zhang YC, Zhao DX, Zhu YH. Effect of Optimizing the Induction Regimen in Preventing Cough Reactions in Patients Undergoing General Anesthesia: A Prospective Randomized Controlled Study. Clin Ther 2024; 46:252-257. [PMID: 38368167 DOI: 10.1016/j.clinthera.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE During the induction of general anesthesia, opioids and endotracheal intubation may cause coughing. This study aimed to investigate the safety and effectiveness of an optimized drug induction scheme for general anesthesia to prevent coughing in patients. METHODS A total of 220 patients aged 18 to 65 years who underwent surgery under general anesthesia with endotracheal intubation were randomly assigned to two groups, each with 110 patients. One group was administered a divided sufentanil bolus (group A) and the other with a single sufentanil bolus (group B). Anesthesia induction was performed according to the drug induction scheme of 1st, 2nd, and 3rd minutes. The primary outcome was a coughing episode associated with the administration of opioids during anesthesia induction. We also recorded the pain associated with drug injection, hemodynamics, and blood oxygen saturation during the induction of anesthesia. FINDINGS All patients were included in the final statistical analysis. Compared with group B, the incidence of opioid induced cough (OIC) was significantly higher in group A (9.1% vs. 0, P = 0.001). There was no cough reaction of tracheal intubation in either group. There was no severe pain due to propofol and rocuronium injection in either group (P > 0.05). The mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation (SpO2) values were within the normal range at each time point during the induction period in both groups. IMPLICATIONS According to the optimized 1st, 2nd, and 3rd minutes anesthesia induction regimen, with a single final intravenous bolus of sufentanil after the diluted rocuronium bromide administration, no sufentanil and tracheal intubation induced coughing reactions were observed. TRIAL REGISTRATION The study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2200062749, http://www.chictr.org.cn/showproj.aspx?proj=175018) on August 17, 2022.
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Affiliation(s)
- Lei Wang
- Department of Anesthesiology, Pinghu First People's Hospital, Jiaxing, China.
| | - Xing Lu
- Department of Anesthesiology, Zhejiang Hospital, Hangzhou, China
| | - Yi Cheng
- Department of Anesthesiology, Pinghu First People's Hospital, Jiaxing, China
| | - You-Chuan Zhang
- Department of Anesthesiology, Pinghu First People's Hospital, Jiaxing, China
| | - De-Xiang Zhao
- Department of Anesthesiology, Pinghu First People's Hospital, Jiaxing, China
| | - Yan-Hong Zhu
- Department of Anesthesiology, Pinghu First People's Hospital, Jiaxing, China
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Chungsamarnyart Y, Pairart J, Munjupong S. Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial. J Perioper Pract 2022; 32:53-58. [PMID: 32301388 DOI: 10.1177/1750458920912636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Coughing and laryngospasm are undesirable consequences occurring when patients awaken from general anaesthesia. The objective of the study aimed to compare the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm. METHODS In all, 120 patients scheduled surgery under general anaesthesia were randomly assigned into three groups. Patients in the control group (C-group) received intravenous 0.9% NaCl, while patients in the propofol group (P-group) received intravenous 0.25mg/kg propofol and patients in the propofol combined with ketamine group (PK-group) received intravenous 0.25mg/kg of propofol plus 0.15mg/kg of ketamine. Drugs were administered before extubation. Incidence and severity of coughing and laryngospasm were recorded by a blinded anaesthesiologist. RESULTS Subjects of the PK-group (25%) experienced significantly reduced incidence of postoperative cough than that in the P-group (55%) and C-group (72.5%) (all P < 0.05). The severity of cough in the PK-group was significantly less than that in the P-group and C-group (P = 0.039 and P < 0.001, respectively). No significant difference was found in the incidence and severity of laryngospasm between comparison groups. CONCLUSION Intravenous combination of propofol and low-dose ketamine significantly reduced the incidence and severity among patients awakening from general anaesthesia.
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Affiliation(s)
- Yanipan Chungsamarnyart
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao Collage of Medicine, Bangkok, Thailand
| | - Jiranun Pairart
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao Collage of Medicine, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao Collage of Medicine, Bangkok, Thailand
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Dong Y, Chang X. Comparison of Five Prophylactically Intravenous Drugs in Preventing Opioid-Induced Cough: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2021; 12:684276. [PMID: 34867314 PMCID: PMC8635493 DOI: 10.3389/fphar.2021.684276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Due to the absence of direct comparisons of different therapeutic drugs in preventing opioid-induced cough (OIC) during the induction of general anesthesia, clinicians often faced difficulties in choosing the optimal drug for these patients. Hence, this network meta-analysis was conducted to solve this problem. Methods: Online databases, including Pubmed, Embase, Web of Science, Cochrane, and Google Scholar, were searched comprehensively to identify eligible randomized controlled trials (RCTs), up to March 15th, 2021. Within a Bayesian framework, network meta-analysis was performed by the “gemtc” version 0.8.2 package of R-3.4.0 software, and a pooled risk ratio (RR) associated with 95% credible interval (CrI) was calculated. Results: A total of 20 RCTs were finally enrolled, and the overall heterogeneity for this study was low to moderate. Traditional pair-wise meta-analysis results indicated that all of the five drugs, namely, lidocaine, ketamine, dezocine, butorphanol, and dexmedetomidine could prevent OIC for four clinical outcomes, compared with the placebo (all p-values < 0.05). Moreover, dezocine had the best effect, compared with that of the other drugs (all p-values < 0.05). Network meta-analysis results suggested that the top three rank probabilities for four clinical outcomes from best to worst were dezocine, butorphanol, and ketamine based on individual/cumulative rank plots and surface under the cumulative ranking curve (SUCRA) probabilities. The node-splitting method indicated the consistency of the direct and indirect evidence. Conclusions: Our results indicated that all of these five drugs could prevent OIC compared with the placebo. Moreover, the top three rank probabilities for four clinical outcomes from best to worst were dezocine, butorphanol, and ketamine. Our results were anticipated to provide references for guiding clinical research, and further high-quality RCTs were required to verify our findings. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021243358].
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Affiliation(s)
- Yunxia Dong
- Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaohan Chang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
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Shafa A, Shahhosseini S, Rajaee E. Comparison of Two Dosages of Ketamine in Preventing Fentanyl-Induced Coughs in Children. Adv Biomed Res 2021; 10:20. [PMID: 34476228 PMCID: PMC8378446 DOI: 10.4103/abr.abr_218_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/20/2020] [Accepted: 10/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fentanyl is a short-acting drug used to induce anesthesia. Here, we aimed to compare the two doses of ketamine to prevent fentanyl-induced cough in children under general anesthesia. MATERIALS AND METHODS This is a randomized, clinical trial which was performed in 2019 in Imam Hossein Hospital in Isfahan, Iran. The study population consisted of children between 6 months and 2 years who were candidates for general anesthesia. Patients were randomized into three groups, each containing 31 patients. Groups 1 and 2 received 0.1 mg/kg and 0.2 mg/kg intravenous ketamine, respectively, 1 min before fentanyl injections. Group 3 received the same volumes of normal saline 0.9%. Patients were observed and evaluated for the incidence and intensity of coughs 1 min and 3 min after fentanyl injections. RESULTS We showed that the frequency of coughs 1 min after fentanyl injection was significantly lower in Group 2 compared to other groups (P < 0.001). Three min after fentanyl injection, the frequencies of coughs were significantly lower in Groups 1 and 2 compared to Group 3 (P < 0.001). We also showed that the intensity of coughs was significantly lower in Group 2 compared to other Groups 1 and 3 min after fentanyl injection (P < 0.001). CONCLUSION The administration of 0.2 mg/kg ketamine is more effective than 0.1 mg/kg dosage in the prevention of fentanyl-induced cough. We also showed that this method could bring more stable hemodynamics and oxygenation saturation inpatients. The comparison of the two dosages was a novel issue in the recent literature.
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Affiliation(s)
- Amir Shafa
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sedighe Shahhosseini
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Rajaee
- Department of Anesthesiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial. Braz J Anesthesiol 2021; 71:381-386. [PMID: 33762196 PMCID: PMC9373669 DOI: 10.1016/j.bjane.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/29/2020] [Accepted: 12/12/2020] [Indexed: 11/22/2022] Open
Abstract
Background and objectives The risk of emergence agitation (EA) is high in patients undergoing nasal surgery. The aim of the present study was to investigate the incidence of EA in adults undergoing septoplasty and the effect of ketamine on EA. Methods In this randomized study, a total of 102 ASA I–II patients who underwent septoplasty between July 2018 and April 2019 were divided into two groups: ketamine (Group-K, n = 52) and saline (Group-S, n = 50). After anesthesia induction, Group-K was intravenously administered 20 mL of saline containing 1 mg kg−1 ketamine, whereas Group-S was administered 20 mL of saline. Sedation and agitation scores at emergence from anesthesia, incidence of cough, emergence time, and response to verbal stimuli time were recorded. The sedation/agitation and pain levels were recorded for 30 minutes in the recovery unit. Results There was no significant difference between the groups in terms of the incidence of EA (Group-K: 15.4%, Group-S: 24%). The incidence of cough during emergence was higher in Group-S than in Group-K, but the response time to verbal stimuli and emergence time were shorter in Group-S. The sedation and agitation scores were similar after surgery. Pain scores were higher in Group-S at the time of admission to the recovery unit and were similar between groups in the other time points. Conclusion Administration of 1 mg kg−1 ketamine after anesthesia induction does not affect the incidence of EA in patients undergoing septoplasty, but it prolongs the emergence and response time to verbal stimuli and reduces the incidence of cough.
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Aydemir S, Alagöz A, Ulus F, Tunç M, Sazak H, Yilmaz Demirci N. Is there any difference between oral preemptive pregabalin vs. placebo administration on response to EBUS-TBNA under sedation? Turk J Med Sci 2021; 51:195-203. [PMID: 33172225 PMCID: PMC7991850 DOI: 10.3906/sag-2005-305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim The aim of this study is to evaluate the effects of preemptive oral pregabalin on hemodynamic response, anxiety, sedation, and recovery in patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under sedation with intravenous ketamine-propofol combination. Materials and methods Sixty patients were included in this study, and patients were randomly divided into two equal groups to receive the placebo (Group 1) versus pregabalin 150 mg (Group 2) one hour prior to EBUS- TBNA procedure. Patients received 0.25 mg kg-1 ketamine and 0.25 mg kg-1 propofol mixture (ketofol) for sedation. Timing of the parameters was defined as follows; T0: in hospital ward before pregabalin or placebo administration, T1: premedication, T2: in operating room, T3: before the procedure, T4: initiation, T5: 3 min after induction, T6: 6 min after induction, T7: 9 min after induction, and T8: 12 min after induction. Hemodynamic parameters, severity of coughing, sedation and anxiety scores, and complications were recorded. The level of satisfaction of the bronchoscopist and the patients were evaluated at the end of the procedure. Results The heart rate and mean arterial pressure were significantly higher in Group 1 (P = 0.008, P = 0.04). Total doses of anesthetics, recovery time, and desaturation rate were significantly higher in Group 1 (P = 0.014, P = 0.001, P = 0.045). In Group 2, SpO2 level was significantly higher at various time periods (T1; P = 0.025, T4; P =0.043, T6; P = 0.001, T7; P = 0.003, T8; P < 0.001). The severity of coughing was found significantly lower in Group 2 (T4; P = 0.011, T5; P = 0.01, T6; P = 0.02, T7; P = 0.03, T8; P < 0.01). Anxiety scores were significantly lower in Group 2 (P < 0.001). Conclusion Preemptive oral pregabalin, in addition to sedation with ketamine-propofol combination, was effective in providing limited hemodynamic response, restricted coughing reflex, and lower anxiety during EBUS-TBNA. Besides, with pregabalin usage, decreased anesthetics consumption, lower complication rate, and shorter recovery time might have contributed to safety of the procedure and comfort of the bronchoscopist.
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Affiliation(s)
- Semih Aydemir
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ali Alagöz
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Fatma Ulus
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Mehtap Tunç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Hilal Sazak
- Department of Anesthesiology and Reanimation, Faculty of Medicine, University of Health Sciences, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Lin W, Sun J, Fu S. A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial. BMC Anesthesiol 2019; 19:164. [PMID: 31455295 PMCID: PMC6712682 DOI: 10.1186/s12871-019-0836-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/20/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Intravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia. METHODS This prospective, randomized, controlled trial was conducted from January 10, 2019 to March 01, 2019. A total of 100 patients undergoing elective surgery under general anesthesia were enrolled, and at last 84 patients were included and randomly allocated into two equal size groups (n = 42): Patients in the Remifentanil group (R group) received an intravenous infusion of remifentanil 0.3 μg/kg (diluted to 2 ml) 1 min before sufentanil injection; patients in the Control group (C group) received 2 ml of normal saline (NS) at the same time point. Injections of patients in both groups were completed within 5 s. Then, sufentanil 0.5 μg/kg was injected within 5 s and the number of coughs that occurred within 1 min after sufentanil injection were recorded. One minute after sufentanil injection, etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were given for general anesthesia induction irrespective of the presence or absence of cough. The mean arterial pressure (MAP) and heart rate (HR) at time points just before remifentanil pretreatment administration (T0), 3 min after administration (T1), 1 min after intubation (T2), and 3 min after intubation (T3) were recorded. RESULTS The incidence of cough in patients in the R group and C group was 4.8 and 31%, respectively. Compared with group C, the incidence and severity of cough in group R was significantly lower (P < 0.01). No significant differences were observed in MAP and HR at the time of general anesthesia induction between the two groups (P > 0.05). CONCLUSION Pretreatment with a small dose of remifentanil effectively and safely reduced the incidence and severity of cough induced by sufentanil during anesthesia induction and can be used as an alternative treatment to inhibit coughing caused by sufentanil. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR1900020587, registered date: January 9, 2019), http://www.chictr.org.cn.
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Affiliation(s)
- Wendong Lin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Jiehao Sun
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China
| | - Shuying Fu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
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Tan W, Li S, Liu X, Gao X, Huang W, Guo J, Wang Z. Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis. Sci Rep 2018; 8:9946. [PMID: 29967371 PMCID: PMC6028622 DOI: 10.1038/s41598-018-27457-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/25/2018] [Indexed: 12/23/2022] Open
Abstract
To evaluate whether different doses of intravenous lidocaine are effective at preventing fentanyl-induced cough (FIC), we searched PubMed, Scopus, Cochrane Library, EMBASE and Web of Science, according to predefined criteria, for all articles published until June 2017. A meta-analysis and subgroup analysis were performed by combining the reported incidence of FIC. The odds ratio (OR) was used as a summary statistic. Eleven articles were included, with 965 patients in the lidocaine group and 745 patients in the control group. A pooled analysis indicated that the overall incidence of FIC was significantly different between the lidocaine group and the control group (OR, 0.27; 95% confidence interval (CI), 0.21-0.35; P < 0.05), as well as between the adult and paediatric subgroups. Sensitivity analysis showed that the results were stable. Subgroup analyses showed that compared to a placebo, both low (0.5-1.0 mg/kg) and high doses of lidocaine (1.5-2.0 mg/kg) were effective at reducing FIC incidence. There was no significant difference between low or high doses of lidocaine. Fentanyl doses added no significant heterogeneity as shown by meta-regression. The findings of this meta-analysis indicate that prophylactic intravenous lidocaine is effective at preventing FIC in both adults and children.
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Affiliation(s)
- Wulin Tan
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Si Li
- The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiaochen Liu
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiang Gao
- Department of Pharmacy, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wenqi Huang
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Junying Guo
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
| | - Zhongxing Wang
- Department of Anaesthesiology, 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.
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Shuying L, Ping L, Juan N, Dong L. Different interventions in preventing opioid-induced cough: a meta-analysis. J Clin Anesth 2016; 34:440-7. [PMID: 27687431 DOI: 10.1016/j.jclinane.2016.05.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cough is one of the most common complications of opioids. Many studies have evaluated the effect of various drugs in preventing opioid-induced cough (OIC). However, there is existing controversy about those reports. The present study was performed to assess the efficacy of different interventions on OIC. METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, and Embase to identify randomized controlled trials on the efficacy of different drugs in the prevention of OIC. Opioids included fentanyl, sufentanil, and remifentanil. We mainly investigated the incidence and severity of OIC after different interventions. RESULTS Thirty-four trials including 9906 patients were analyzed in this study. Twenty different drugs were reported, and 10 drugs were indentified in more than 2 articles. These drugs, including lidocaine, ketamine, dexmedetomidine, priming of fentanyl, propofol, dezocine, dexamethasone, dextromethorphan, and magnesium sulfate (MgSO4), showed a significant efficacy compared with controls. There were insufficient numbers of trials for salbutamol, clonidine, tramadol, pentazocine, rocuronium, midazolam, atropine, terbutaline, sodium chromoglycate, beclomethasone, and ephedrine. From these data, we found that salbutamol, tramadol, midazolam, and atropine were ineffective. CONCLUSIONS This meta-analysis suggested that the prophylactic administration of lidocaine, ketamine, dexmedetomidine, priming of fentanyl, propofol, and dezocine was effective in preventing OIC.
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Affiliation(s)
- Li Shuying
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China
| | - Li Ping
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China
| | - Ni Juan
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China
| | - Luo Dong
- Department of Anesthesiology, West China Second Hospital of Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, China.
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Safavi M, Honarmand A, Khazaei M. The effects of propofol, ketamine and combination of them in prevention of coughing and laryngospasm in patients awakening from general anesthesia: A randomized, placebo-controlled, double blind clinical trial. Adv Biomed Res 2016; 5:64. [PMID: 27135033 PMCID: PMC4832885 DOI: 10.4103/2277-9175.179186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 06/11/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Coughing and laryngospasm are undesirable outcomes occurring during emergence from general anesthesia. We compared the effect of small doses of propofol, ketamine and a combination of them on the occurrence and severity of coughing and laryngospasm in patients awakening from general anesthesia. MATERIALS AND METHODS 160 patients who were scheduled to undergo operations under general anesthesia were randomly assigned to one of the following groups, 40 in each group: propofol group (0.25 mg/kg intravenous (IV) propofol), ketamine group (0.25 mg/kg IV ketamine), combination group (0.25 mg/kg IV propofol, and 0.25 mg/kg IV ketamine) and control (0.1 ml/kg IV saline). Drugs were administered before extubation at previously defined time. Presence and severity of coughing and laryngospasm were recorded within twominutes after extubation. RESULTS The presence of coughing in the combination group (27.5%) was less than that in other groups; also it was less frequent in the propofol group (57.5%) than the control (82.5%) (all P < 0.05). But the incidence did not differ between the propofol and the ketamine (70%) group; nor did it differ between the ketamine and control groups (P = 0.356 and P = 0.121, respectively). The cases with severe coughing (grade 3) in the combination group (none) were significantly less than in the propofol (four) and the control groups (seven) (P = 0.040 and P = 0.006 respectively). There was no significant difference between the groups in frequency of laryngospasm. CONCLUSION Administration of propofol or combination of propofol and ketamine decreases the incidence of post extubation coughing. This combination can also decrease severe cases.
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Affiliation(s)
- Mohammadreza Safavi
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azim Honarmand
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Khazaei
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim JE, Min SK, Chae YJ, Lee YJ, Moon BK, Kim JY. Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis. J Anesth 2014; 28:257-66. [PMID: 23958914 DOI: 10.1007/s00540-013-1695-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022]
Abstract
Fentanyl-induced cough (FIC) is often observed after intravenous bolus administration of fentanyl during anesthesia induction. This meta-analysis assessed the efficacy of pharmacological and nonpharmacological interventions to reduce the incidence of FIC. We searched for randomized controlled trials comparing pharmacological or nonpharmacological interventions with controls to prevent FIC; we included 28 studies retrieved from Pub-Med, Embase, and Cochrane Library. Overall incidence of FIC was approximately 31 %. Lidocaine [odds ratio (OR) = 0.29, 95 % confidence interval (CI) 0.21–0.39], N-methyl-D-aspartate (NMDA) receptor antagonists (OR 0.09, 95 % CI 0.02–0.42), propofol (OR 0.07, 95 % CI 0.01–0.36), a2 agonists (OR 0.32, 95 % CI 0.21–0.48), b2 agonists (OR 0.10, 95 % CI 0.03–0.30), fentanyl priming (OR 0.33, 95 % CI 0.19–0.56), and slow injection of fentanyl (OR 0.25, 95 % CI 0.11–0.58)] were effective in decreasing the incidence of FIC, whereas atropine (OR 1.10, 95 % CI 0.58–2.11) and benzodiazepines (OR 2.04, 95 % CI 1.33–3.13) were not effective. This meta-analysis found that lidocaine, NMDA receptor antagonists, propofol, a2 agonists, b2 agonists, and priming dose of fentanyl were effective in preventing FIC, but atropine and benzodiazepines were not. Slow injection of fentanyl was effective in preventing FIC, but results depend on the speed of administration.
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Saleh AJ, Zhang L, Hadi SM, Ouyang W. A priming dose of intravenous ketamine-dexmedetomidine suppresses fentanyl-induced coughing: a double-blind, randomized, controlled study. Ups J Med Sci 2014; 119:333-7. [PMID: 25367551 PMCID: PMC4248073 DOI: 10.3109/03009734.2014.968270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE This study was designed to investigate whether a priming dose of ketamine-dexmedetomidine can effectively suppress fentanyl-induced coughing (FIC). METHODS Altogether 400 patients of ASA I and II, aged 18-70 years, undergoing various elective surgical procedures, were randomly allocated into four groups of 100 patients each. Patients in the placebo group received volume-matched normal saline 0.15 mL/kg + normal saline 0.05 mL/kg. One group of patients was given ketamine 0.15 mg/kg + normal saline 0.05 ml/kg (KET), and another group dexmedetomidine 0.5 μg/kg + normal saline 0.05 ml/kg (DEX). Finally, one group of patients received ketamine 0.15 mg/kg + dexmedetomidine 0.5 μg/kg (KETODEX). After fentanyl administration, the onset time and severity of cough for 1 min were recorded. Cough severity was graded as mild (grade 1-2), moderate (grade 3-5), or severe (grade >5). RESULT The incidence of FIC was 53%, 34%, 20%, and 9% in the placebo, DEX, KET, and KETODEX groups, respectively. The incidence of cough was significantly lower in the KETODEX group. Likewise, the onset time of cough was significantly delayed in the KETODEX group. Only nine patients in the KETODEX group had either mild (6%) or moderate (3%) cough, with none suffering from severe cough. CONCLUSION A priming dose of KETODEX effectively suppressed the cough reflex induced by fentanyl and delayed the onset time of cough. Therefore, treatment with KETODEX may be a clinically useful method for preventing FIC.
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Affiliation(s)
- Amin J Saleh
- Department of Anesthesiology, The Third Xiangya Hospital, Central South University , Changsha, Hunan , P.R. China
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Opioid analgesics and narcotic antagonists. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/b978-0-444-62635-6.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
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Sun L, Guo R, Sun L. The impact of prophylactic intravenous lidocaine on opioid-induced cough: a meta-analysis of randomized controlled trials. J Anesth 2013; 28:325-33. [PMID: 24173406 DOI: 10.1007/s00540-013-1732-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Opioids are commonly used for general anesthesia, but reflex cough can occur after an intravenous injection. We have performed a meta-analysis of randomized controlled trials (RCTs) that evaluated the effectiveness and safety of prophylactic lidocaine administered intravenously (IV) on opioid-induced cough (OIC) during induction in patients undergoing general anesthesia. METHODS We searched three bibliographic databases (PubMed, Embase, and the Cochrane Central Register of Controlled Trials) to identify studies meeting a priori inclusion criteria and also conducted a secondary reference review. The information used to calculate the relationship between lidocaine prophylaxis and the risk and severity of OIC was extracted by two principal investigators, respectively. RESULTS Six RCTs with a total of 1,740 participants were included in this meta-analysis. Overall, prophylactic lidocaine administered IV reduced both the risk of OIC [pooled risk ratio (RR) 0.471; 95 % confidence interval (CI) 0.355-0.625; P = 0.074; heterogeneity test, I (2) = 50.3 %] and its severity (weighed mean difference -0.316; 95 % CI -0.480 to -0.151; P = 0.038; heterogeneity test, I (2) = 60.5 %). Sub-group analysis indicated a significant reduction in the incidence of both fentanyl-induced cough (FIC) and remifentanil-induced cough (RIC), but it appeared that lidocaine only alleviated the severity of FIC. Further sub-group analysis indicated that the lowest effect dose of lidocaine for preventing the prevalence of OIC was 0.5 mg/kg. No severe adverse effects were reported. CONCLUSIONS Our meta-analysis establishes the effectiveness of prophylactic lidocaine administered IV for the prevention of OIC during induction. The lowest effective dose of lidocaine on the risk of OIC appeared to be 0.5 mg/kg.
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Affiliation(s)
- Liang Sun
- Department of Anesthesiology, Cancer Institute and Hospital, National Cancer Center, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 17 Panjiayuannanli Road, Chaoyang District, Beijing, 100021, China
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