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He LX, Yao YT, Shao K, Zhao YY, Ma J. Efficacy of dezocine on preventing opioid-induced cough during general anaesthesia induction: a PRISMA-compliant systematic review and meta-analysis. BMJ Open 2022; 12:e052142. [PMID: 35379614 PMCID: PMC8981282 DOI: 10.1136/bmjopen-2021-052142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To systematically review the effects of dezocine (DZC) on the occurrence rate and severity of opioid-induced cough (OIC). DESIGN Systematic review and meta-analysis DATA SOURCES: PubMed, Embase, Cochrane Library, Ovid, Web of Science as well as Chinese BioMedical Literature & Retrieval System, China National Knowledge Infrastructure, Wanfang and VIP Data were searched from 1978 to 31 December 2020. INCLUSION CRITERIA All randomised controlled trials (RCTs) comparing DZC with placebo on the occurrence rate and severity of OIC. DATA ANALYSIS All data were analysed by using RevMan V.5.3. Each outcome was tested for heterogeneity, and randomised-effects or fixed-effects model was used in the presence or absence of significant heterogeneity. RESULTS Our search yielded 33 RCTs including 4442 patients, and 2521 patients were allocated into the DZC group and 1921 into the control group. Fentanyl was administrated in 1880 patients and sufentanil in 2562 patients during the induction of general anaesthesia. The meta-analysis demonstrated that DZC significantly reduced the occurrence rate of OIC induced by either fentanyl (8.8% vs 49.7%, OR=0.07, 95% CI 0.04 to 0.12, p<0.00001) or sufentanil (5.0% vs 41.5%, OR=0.07, 95% CI 0.04 to 0.12, p<0.00001). The meta-analysis also indicated that the occurrence rate of mild, moderate and severe OIC in the DZC group was remarkably lower than that of the control group (mild: 3.6% vs 13.6%, OR=0.19, 95% CI 0.14 to 0.25, p<0.00001; moderate: 2.0% vs 13.6%, OR=0.12, 95% CI 0.09 to 0.18, p<0.00001; severe: 1.0% vs 13.9%, OR=0.08, 95% CI 0.05 to 0.12, p<0.00001). Additionally, the current meta-analysis indicated that DZC pretreatment was not associated with increased occurrence rate of adverse effects (7.0% vs 4.2%, OR=2.34, 95% CI 0.60 to 9.14, p=0.22) except for dizziness (11.8% vs 0%, OR=8.06, 95% CI 1.40 to 46.35, p=0.02). CONCLUSION This meta-analysis demonstrated that DZC significantly inhibited OIC and may be used to manage OIC. More high-quality RCTs are needed to complement the safety of DZC. PROSPERO REGISTRATION NUMBER CRD42019141255.
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Affiliation(s)
- Li-Xian He
- Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
- Anesthesiology, Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yun-Tai Yao
- Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Ken Shao
- Anesthesiology, Jingmen No. 1 People's Hospital, Jingmen, Hubei, China
| | - Yuan-Yuan Zhao
- Anesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Jie Ma
- Pharmacy, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
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Phuvachoterojanaphokin N, Watanaboonyongcharoen G, Jinawong S, Munjupong S. Low-dose lidocaine attenuates fentanyl-induced cough: A double-blind randomized controlled trial. Eur J Clin Pharmacol 2022; 78:813-821. [PMID: 35089372 DOI: 10.1007/s00228-022-03282-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The study aimed to determine the efficacy of lidocaine at different low doses to reduce fentanyl-induced cough (FIC). METHODS Three hundred twenty patients aged from 18 to 60 years with ASA I and II scheduled for general anesthesia were randomly assigned to 4 groups to obtain peripheral intravenous 0.9%NaCl (Group I), lidocaine 0.25 mg/kg (Group II), 0.5 mg/kg (Group III) or 1.0 mg/kg (Group IV) 2 min before 3 μg/kg of fentanyl intravenously in a prospective randomized controlled fashion. The primary result was incidence of cough among comparison groups. The secondary results included severity of cough, hemodynamic response and risk factors of FIC. RESULTS Thirty-two, 15, 13 and 11 patients (40, 18.8, 16.3 and 13.8%) presented incidence of cough in Groups I, II, III and IV, respectively (P < 0.05 Group I vs. II, III and IV). No significant difference was observed in the incidence and severity of cough among the lidocaine groups (P > 0.05). Multivariate analysis showed that age ≤ 40 years, nonsmoking and patients not receiving the prior lidocaine injection were risk factors of FIC (P = 0.007, 0.013 and 0.001, respectively). CONCLUSION The study implied intravenous lidocaine 0.25 mg/kg for 2 min before fentanyl injection was the most effective dose to suppress FIC and could be applied in daily practice. Patients aged less than 40 years and nonsmoking were risk factors of FIC, regardless of sex and underlying disease.
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Affiliation(s)
- Nuanwan Phuvachoterojanaphokin
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Grit Watanaboonyongcharoen
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Sarita Jinawong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand
| | - Sithapan Munjupong
- Department of Anesthesiology, Phramongkutklao Hospital and Phramongkutklao College of Medicine, 10400, Bangkok, Thailand.
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Chen R, Tang LH, Sun T, Zeng Z, Zhang YY, Ding K, Meng QT. Mechanism and Management of Fentanyl-Induced Cough. Front Pharmacol 2020; 11:584177. [PMID: 33324214 PMCID: PMC7723435 DOI: 10.3389/fphar.2020.584177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022] Open
Abstract
Fentanyl-induced cough (FIC) often occurs after intravenous bolus administration of fentanyl analogs during induction of general anesthesia and analgesia procedure. The cough is generally benign, but sometimes it causes undesirable side effects, including elevated intra-abdominal, intracranial or intraocular pressure. Therefore, understanding the related mechanisms and influencing factors are of great significance to prevent and treat the cough. This paper reviews the molecular mechanism, influencing factors and preventive administration of FIC, focusing on the efficacy and side effects of various drugs in inhibiting FIC to provide some medical reference for anesthesiologists.
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Affiliation(s)
- Rong Chen
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling-Hua Tang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tao Sun
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zi Zeng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yun-Yan Zhang
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Ding
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing-Tao Meng
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, China.,Department of Anesthesiology, East Hospital, Renmin Hospital of Wuhan University, Wuhan, China
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Ma R, Wei Y, Xu Z. A small dose of dezocine suppresses remifentanil-induced cough in general anesthesia induction: a prospective, randomized, controlled study. BMC Anesthesiol 2020; 20:235. [PMID: 32938386 PMCID: PMC7493863 DOI: 10.1186/s12871-020-01156-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this prospective randomized controlled study was to evaluate whether pretreatment with a small dose of dezocine could prevent remifentanil-induced cough in general anesthesia induction. Trial design a prospective, randomized, controlled study. Methods A total of 210 patients receiving elective operative hysteroscopy from December 2018 to April 2019 were enrolled in the present study. They were randomly equally separated into dezocine group (n = 105) and control group (n = 105). Patients were intravenously pre-administrated with dezocine 0.03 mg/kg (diluted to 5 mL) or the same volume of normal saline 1 min prior to remifentanil infusion. One minute later, intravenous injection of propofol 1.5 mg/kg and cisatracurium 0.1 mg/kg were given to all patients for induction of general anesthesia. The counts of coughs occurred during the anesthesia induction period were recorded and the severity of cough was scaled. Results There were 7 cases of mild cough in dezocine group and 18 cases of mild cough, 12 cases of moderate cough and 4 cases of severe cough in control group. The incidence rate of cough was significantly lower and the severity of cough was obviously relieved in dezocine group compared to control group (6.67% vs. 32.38%, P < 0.001). The two groups were not significantly different in heart rate and mean arterial pressure before the induction, before and after the intubation, and in operating time and postoperative visual analog scale pain scores. Conclusion This study recommends the efficacy and safety of a pretreatment with a small dose of dezocine in reducing remifentanil-induced cough during general anesthesia. Trial Registration ChiCTR2000032035. Date of registration: Retrospectively registered on 2020/04/18.
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Affiliation(s)
- Rui Ma
- Department of Anesthesiology, international Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Key Laboratory of Embryo Original Disease, Shanghai Municipal Key Clinical Specialty, Shanghai Jiao Tong University, Huashan Rd. 1961, Shanghai, 200030, China
| | - Yu Wei
- Department of Anesthesiology, international Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Key Laboratory of Embryo Original Disease, Shanghai Municipal Key Clinical Specialty, Shanghai Jiao Tong University, Huashan Rd. 1961, Shanghai, 200030, China
| | - Zifeng Xu
- Department of Anesthesiology, international Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Key Laboratory of Embryo Original Disease, Shanghai Municipal Key Clinical Specialty, Shanghai Jiao Tong University, Huashan Rd. 1961, Shanghai, 200030, China. .,Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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He LX, Shao K, Ma J, Zhao YY, Yao YT. Is dezocine effective and safe in preventing opioids-induced cough during general anaesthesia induction? A protocol for systematic review and meta-analysis. BMJ Open 2020; 10:e035691. [PMID: 32554726 PMCID: PMC7304830 DOI: 10.1136/bmjopen-2019-035691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cough is often observed when administrating a bolus of opioids. Opioid-induced cough (OIC) is mostly transient, benign and self-limiting, but could be associated with adverse effects. Numerous pharmacological and non-pharmacological interventions have been used to manage OIC with controversial efficacy and safety. Recent studies suggested that, pretreatment of intravenous dezocine (DZC) could completely suppress OIC during anaesthesia induction. To address this knowledge lack, we will perform a systemic review and meta-analysis to evaluate the efficacy of DZC on OIC and possible complications. We provide here a protocol that will outline the methods and analyses planned for the systematic review. METHODS PubMed, Embase, Cochrane Library, Web of Science as well as Chinese BioMedical Literature & Retrieval System (SinoMed), China National Knowledge Infrastructure, Wanfang Data and VIP Data will be searched from 1978 to 31 December 2019 to identify all randomised controlled trials comparing DZC with placebo on the incidence and severity of OIC. Primary outcomes of interest include the incidence and severity of OIC. Secondary outcomes of interest include possible complications or adverse effects of DZC. Two authors will independently extract relevant variables and outcome data. For continuous variables, treatment effects will be calculated as weighted mean difference and 95% CI. For dichotomous data, treatment effects will be calculated as OR and 95% CI. Each outcome will be tested for heterogeneity, and randomised-effects or fixed-effects model will be used in the presence or absence of significant heterogeneity. Sensitivity analyses will be done by examining the influence of statistical model and individual trial(s) on estimated treatment effects. Publication bias will be explored through visual inspection of funnel plots of the outcomes. Statistical significance will be defined as p<0.05. ETHICS AND DISSEMINATION This study is a protocol of meta-analysis of previously published literatures, ethical approval was not necessary according to the Ethical Committee of Fuwai Hospital. The study will be submitted to a peer-reviewed journal and disseminated via research presentations. PROSPERO REGISTRATION NUMBER CRD42019141255.
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Affiliation(s)
- Li-Xian He
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ken Shao
- Department of Anesthesiology, Jingmen No. 1 People's Hospital, Jingmen, China
| | - Jie Ma
- Department of Pharmacy, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuan-Yuan Zhao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Wang J, Duan J, Wang Q, Lu Y. Pretreatment with Nalbuphine Prevents Sufentanil-Induced Cough During the Anesthesia Induction: A Randomized Controlled Trial. Ther Clin Risk Manag 2020; 16:281-286. [PMID: 32341646 PMCID: PMC7166053 DOI: 10.2147/tcrm.s247437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/27/2020] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Jiang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
| | - Jinjuan Duan
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China.,Department of Anesthesiology, Affiliated Anqing Hospital of Anhui Medical University, Anqing 246003, People's Republic of China
| | - Qiuyue Wang
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
| | - Yao Lu
- Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
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He J, Zhu L, Zhu H, Gu X, Li P, Yang Y, Yang L. Dose selection of central or peripheral administration of sufentanil affect opioid induced cough?: a prospective, randomized, controlled trial. BMC Anesthesiol 2018; 18:38. [PMID: 29636004 PMCID: PMC5894202 DOI: 10.1186/s12871-018-0502-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 03/29/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Opioid-induced cough (OIC) is one of the most common complications of opioids during anesthesia induction. This study was designed to assess the incidence of OIC mediated by different intravenous route. METHODS A total of 102(ASA I-II) scheduled for elective surgery under general anesthesia were randomly allocated into two groups: central vein group (group CV, n = 51) and peripheral vein group (group PV, n = 51). The incidence, onset time and severity of OIC were evaluated within 1 min just after sufentanil injection during induction. Meanwhile, heart rate (HR) and blood pressure (BP) were also recorded to assess the hemodynamic changes. RESULTS The incidence of OIC was 10/51 (20.4%) in group CV and 16/51 (32%) in group PV, patients received central venous administration of sufentanil experienced less OIC compared with those injected by peripheral venous route (P < 0.05), as well as a significantly lower incidence of severe OIC (P < 0.05). Nevertheless, the onset of OIC and hemodynamic data were comparable between two groups (P > 0.05). CONCLUSION Our study indicates that sufentanil administration by central venous route reduces the incidence and severity of OIC, but without significant changes in hemodynamic status. TRIAL REGISTRATION Chinese Clinical Trial Registry with registration number ChiCTR-IOR-15006075 . Registered 28 February 2015.
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Affiliation(s)
- Jiabei He
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Ling Zhu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Huichen Zhu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Xinyu Gu
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Peiying Li
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Yuting Yang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
| | - Liqun Yang
- Department of Anesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127 China
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Cho CK, Kim JE, Yang HJ, Sung TY, Kwon HU, Kang PS. The effect of combining lidocaine with dexamethasone for attenuating postoperative sore throat, cough, and hoarseness. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.1.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Choon-Kyu Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Ji-Eun Kim
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hun-Ju Yang
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hee-Uk Kwon
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Po-Soon Kang
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Liu XS, Xu GH, Shen QY, Zhao Q, Cheng XQ, Zhang J, Gu EW. Dezocine prevents sufentanil-induced cough during general anesthesia induction: A randomized controlled trial. Pharmacol Rep 2014; 67:52-5. [PMID: 25560575 DOI: 10.1016/j.pharep.2014.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 08/07/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Opioid-induced cough during induction of general anesthesia is a common phenomenon. Dezocine, a partial μ-receptors agonist and κ-receptors antagonist, has been documented effectively suppressing fentanyl-induced cough in general anesthesia induction. However, the effect of dezocine on sufentanil-induced cough is still unknown. METHODS A total of 370 patients (American Society of Anesthesiologists physical status I-II), aged 18-70 years, undergoing elective surgery, were randomly divided into a control group (group C) and a dezocine group (group D) (n=185 in each group). Patients received dezocine 0.1mg/kg or an equal volume of 0.9% normal saline 2 min prior to intravenous sufentanil (0.5 μg/kg). The incidence and reflex degree of cough in patients were evaluated within 2 min after the injection of sufentanil in anesthesia induction period. RESULTS No patient in group D had cough and 59 patients in group C had cough (severity of cough: mild, 7%; moderate, 11.4%; severe, 13.5%). The occurrence and reflex degree of cough in group D was significantly lower than that in group C (P=0.000). The highest heart rate (HR) and invasive blood pressure (IBP) values were higher in group C than those in group D (P<0.01) within 2 min after sufentanil administration, althought these values remained within safe limits. CONCLUSION The results of current study suggest that administration of Dezocine 0.1mg/kg may effectively prevent the occurrence and reflex degree of sufentanil-induced irritating cough in general anesthesia induction in patients.
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Affiliation(s)
- Xue-Sheng Liu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China
| | - Guang-Hong Xu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China
| | - Qi-Ying Shen
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China
| | - Qing Zhao
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China
| | - Xin-Qi Cheng
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China
| | - Jian Zhang
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China
| | - Er-Wei Gu
- Department of Anesthesiology, First Affiliated Hospital, Anhui Medical University, Anhui, China.
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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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Honarmand A, Safavi M, Khalighinejad F. A comparison of the effect of pretreatment with intravenous dexamethasone, intravenous ketamine, and their combination, for suppression of remifentanil-induced cough: A randomized, double-blind, placebo-controlled clinical trial. Adv Biomed Res 2013; 2:60. [PMID: 24223375 PMCID: PMC3814903 DOI: 10.4103/2277-9175.115808] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 12/16/2012] [Indexed: 12/02/2022] Open
Abstract
Background: The injection of remifentanil can cause cough during induction of anesthesia. This study was designed to examine the efficacy of ketamine, dexamethasone, and their combination on remifentanil-induced cough (RIC). Materials and Methods: One hundred and twenty patients scheduled for elective surgery were randomly assigned into four groups: Group K received 10 mg ketamine; Group D received 10 mg dexamethasone; Group KD received 10 mg ketamine in combination with dexamethasone; and Group S received saline in a similar volume, five minutes prior to the injection of remifentanil. The incidence and severity of the cough was recorded in each person. Results: The incidence of RIC was significantly lower in Group KD compared to Group K, Group D, and Group S (3.3 vs. 20%, 20%, and 46.7%, respectively, P < 0.05). The severity of RIC was significantly lower in Group KD compared to Group K, Group D, and Group S (P < 0.05). There was no significant difference between Group K and Group D in this regard (P > 0.05). There was no significant difference in the onset time of coughing among the four groups (19.8 ± 1.3, 20.8 ± 0.9, 19.0 ± 1.1, and 19.9 ± 2.2 in Group K, Group D, Group KD, and Group S, respectively, P > 0.05). Conclusion: We found that pretreatment with 10 mg ketamine in combination with 10 mg dexamethasone five minutes prior to the injection of remifentanil could significantly reduce the incidence of RIC, and it was better than using each drug singly.
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Affiliation(s)
- Azim Honarmand
- Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Kim JY, Chae YJ, Kim JS, Park YJ, Min SK. A target-controlled infusion regimen for reducing remifentanil-induced coughs. Korean J Anesthesiol 2012; 63:30-5. [PMID: 22870362 PMCID: PMC3408512 DOI: 10.4097/kjae.2012.63.1.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/18/2011] [Accepted: 12/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluates the effectiveness of the target-controlled infusion (TCI) of remifentanil through stepwise increases in the effect-site concentration (C(eff)) in preventing coughs. METHODS In a preliminary study, we randomly selected 140 patients to receive remifentanil through two-step increases in C(eff) (1.0 ng/ml to 4.0 ng/ml: Group R(1-4); 2.0 ng/ml to 4.0 ng/ml: Group R(2-4)). Based on the results of the preliminary study, we employed another sample of 140 patients and implemented a three-step increase in TCI (1.0 ng/ml to 2.0 ng/ml to 4.0 ng/ml: Group R(1-2-4)). We then compared this treatment with direct targeting based on 4.0 ng/ml TCI (Group R(4)). We recorded the episodes of coughs, rating them as mild (1-2), moderate (3-4), or severe (5 or more). RESULTS In Group R(1-4), one patient (1.5%) coughed during the first step, and five (7.3%) coughed during the second step. In Group R(2-4), nine (13.2%) coughed during the first step, but none coughed during the next step. Only one patient had a mild cough during the three-step increase in TCI, that is, patients in Group R(1-2-4) were significantly less likely to cough than those in Group R(4) (P < 0.001). CONCLUSIONS Stepwise increases in the TCI of remifentanil reduced the incidence of remifentanil-induced coughing, and the three-step increase in TCI nearly eliminated remifentanil-induced coughing.
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Affiliation(s)
- Jong-Yeop Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yun Jeong Chae
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Soo Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yoon-Jeong Park
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Sang-Kee Min
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea
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Rafiei MR, Arianpour N, Rezvani M, Ebrahimi A. Effects of intracuff dexamethasone on post-extubation reactions. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2012; 17:338-43. [PMID: 23267394 PMCID: PMC3526126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/25/2011] [Accepted: 01/28/2012] [Indexed: 10/31/2022]
Abstract
BACKGROUND The most common complications after tracheal intubation during general anesthesia are sore throat, hoarseness, and laryngospasm which can cause severe discomfort to patients. Several methods have been suggested to prevent these complications. In this study, the effects of intracuff dexamethasone, lidocaine, and normal saline in reducing post-extubation reactions were compared. METHODS This double-blind clinical trial was performed on 180 men of ASA (American Society of Anesthesiologists) class I or II who underwent general anesthesia for elective inguinal herniation surgery in Imam Reza Hospital, Tehran, Iran during 2008-2010. Depending on the kind of drug used to fill the endotracheal tube (ETT) cuff, patients were randomly allocated into normal saline, lidocaine, and dexamethasone groups. Post-extubation reactions were then evaluated in all groups. RESULTS The groups were demographically comparable. There were no significant differences between the three groups regarding post-extubation sore throat, hoarseness, or laryngospasm (p > 0.05). However, a significant difference in cough existed between the three groups (p = 0.02). Moreover, the groups were not significantly different in terms of patient satisfaction after 24 hours (p = 0.062). Prolongation of spontaneous ventilation time and time to extubation were observed in the three groups. No significant differences were detected between the three groups regarding hemodynamic variables. CONCLUSION The three drugs were not significantly different in attenuating post-extubation reactions such as hoarseness, sore throat, and laryngospasm. However, lidocaine was more effective on cough incidence while dexamethasone had better efficacy in reducing cough severity. In addition, all three drugs could satisfy patients after 24 hours. ETT tolerance was more in the lidocaine group than the other two groups.
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Affiliation(s)
- Mohammad Reza Rafiei
- Assistant Professor, Department of Anesthesiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran,Address for correspondence: Mohammad Reza Rafiei, Assistant Professor, Department of Anesthesiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran. E-mail:
| | - Nahid Arianpour
- Assistant Professor, Department of Microbiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Mehraneh Rezvani
- Assistant Professor, Department of Anesthesiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Azizollah Ebrahimi
- Assistant Professor, Department of Anesthesiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Sun ZT, Yang CY, Cui Z, Zhang J, Han XP. Effect of intravenous dezocine on fentanyl-induced cough during general anesthesia induction: a double-blinded, prospective, randomized, controlled trial. J Anesth 2011; 25:860-3. [PMID: 21935685 DOI: 10.1007/s00540-011-1237-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/07/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To evaluate the suppressive effect of intravenous dezocine on fentanyl-induced cough during the induction of general anesthesia. METHODS A total of 120 patients, American Society of Anesthesiologists (ASA) physical status I-II, were randomized into two equally sized groups (n = 60). These two groups were given either intravenous dezocine 0.1 mg/kg or a matching placebo (equal volume of 0.9% saline) 10 min before the induction of general anesthesia. Patients were induced with midazolam 0.1 mg/kg, fentanyl 5 μg/kg, propofol 1-1.5 mg/kg, and suxamethonium 1.5 mg/kg. The injection time of fentanyl was less than 2 s in all patients. The occurrence of cough was recorded 2 min after fentanyl bolus. RESULTS No patient in the dezocine group had cough, and 42 patients in the control group had cough. This difference was statistically different between these two groups (P = 0.000). CONCLUSION These results demonstrate that intravenous dezocine 0.1 mg/kg 10 min prior to induction was effective in suppressing fentanyl-induced cough in our patients.
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Affiliation(s)
- Zhen-Tao Sun
- Department of Anesthesia, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Affiliation(s)
- Jong In Han
- Department of Anesthesiology and Pain Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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