Effect of Different Doses of Ketamine on Fentanyl-Induced Cough
Abstract
Background: Reflex cough is a common complication after fentanyl injection during anesthesia. Several studies have tried different medications to control fentanyl-induced cough (FIC).
Aim: Our study evaluated the effect of different ketamine dosage on preventing fentanyl induced cough.
Methods: We randomly assigned 80 participants into four groups. Group 1 was administered 0.15 mg/kg, Group 2 received 0.2 mg/kg, Group 3 was given 0.25 mg/kg of intravenous ketamine one minute prior to fentanyl injections, while Group 4 received an equivalent volume of 0.9% normal saline.
Results: The incidence and severity of cough was evaluated by FIC score. The incident of cough was significantly lower in Groups 3, 2 and 1 in comparison to Group 4 (0, 5, 30 respectively vs 85, p<0.001). The cough severity was significantly lower in Groups 3, 2 and 1 in comparison to Group 4 (p<0.001).
Conclusion: Intravenous ketamine 0.25 mg/kg, significantly decreased the severity and frequency of cough compared with 0.20 and 0.15 mg/kg IV ketamine.
[2] Armenian P, Vo KT, Barr-Walker J, Lynch KL. Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive review. Neuropharmacology. 2018; 134:121-32.
[3] Suzuki J, El-Haddad S. A review: fentanyl and non-pharmaceutical fentanyls. Drug Alcohol Depend. 2017; 171:107-16.
[4] Somerville NJ, O’Donnell J, Gladden RM, Zibbell JE, Green TC, Younkin M, et al. Characteristics of fentanyl overdose—Massachusetts, 2014–2016. MMWR Morb Mortal Wkly Rep. 2017; 66(14):382.
[5] Horng H-C, Lin B-F, Wang T-C, Lin S-L, Liaw W-J, Wang H-J, et al. Priming dose of intravenous rocuronium suppresses fentanyl-induced coughing. Acta Anaesthesiol Taiwan. 2012; 50(4):147-9.
[6] Nazemroaya B, Honarmand A, Bab Hadi Ashar M. Effects of adding dexmedetomidine to ketamine on heart rate and blood pressure changs in psychiatric patients undergoing electroconvulsive therapy. Koomesh. 1399; 22 (2) :311-316
[7] Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, et al. Ketamine and ketamine metabolite pharmacology: insights into therapeutic mechanisms. Pharmacol Rev. 2018; 70(3):621-60.
[8] Yeh C-C, Wu C-T, Huh BK, Lee M-S, Lin S-L, Sheen MJ, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth. 2007; 19(1):53-6.
[9] Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004; 4(1):1-6.
[10] Phillips NM, Haesler E, Street M, Kent B. Post-anaesthetic discharge scoring criteria: a systematic review. JBI Libr Syst Rev. 2011; 9(41):1679-713.
[11] El Baissari M, Taha SK, Siddik-Sayyid SM. Fentanyl-induced cough--pathophysiology and prevention. Middle East J Anaesthesiol. 2014; 22(5):449-56.
[12] Ambesh S, Singh N, Srivastava K. Fentanyl induced coughing caused life-threatening airway obstruction in a patient with arteriovenous malformation of tongue and hypopharynx. Int J Anesthesiol. 2009; 20(20):7.
[13] Cho HB, Kwak H, Park S, Kim J. Comparison of the incidence and severity of cough after alfentanil and remifentanil injection. Acta Anaesthesiol Scand. 2010; 54(6):717-20.
[14] Shen J-C, Xu J-G, Zhou Z-Q, Liu H-J, Yang J-J. Effect of equivalent doses of fentanyl, sufentanil, and remifentanil on the incidence and severity of cough in patients undergoing abdominal surgery: a prospective, randomized, double-blind study. Curr Ther Res Clin Exp. 2008; 69(6):480-7.
[15] Tweed WA, Dakin D. Explosive coughing after bolus fentanyl injection. Anesth Analg. 2001; 92(6):1442-3.
[16] Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D, et al. Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced byiv fentanyl. Can J Anaesth. 2003; 50(3):297-300.
[17] Horng HC, Wong CS, Hsiao KN, Huh B, Kuo CP, Cherng CH, et al. Pre‐medication with intravenous clonidine suppresses fentanyl‐induced cough. Acta Anaesthesiol Scand. 2007; 51(7):862-5.
[18] Nazemroaya, B., Shafa, A., Khizab, M. Comparison of the Effect of Ketamine and Sodium Thiopental on Blood Pressure and Heart Rate during Electroconvulsive Therapy in Patients Admitted to the Ward of Psychiatry; A Double-Blind Randomized Clinical Trial. Journal of Isfahan Medical School, 2016; 34(402): 1197-1204.
Files | ||
Issue | Article in Press | |
Section | Research Article(s) | |
Keywords | ||
cough fentanyl ketamine |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |