Chandra Kant Pandey MD, Mehdi Raza MD, Rajeev Ranjan MD, et al. Intravenous lidocaine 0.5 mg·kg–1 effectively suppresses fentanyl-induced cough. CAN J ANESTH, 2005;52(2 ):172–175.
.......
The mechanisms of fentanyl-induced cough are not
well understood, but various theories have been proposed.
Fentanyl inhibits central sympathetic outflow
causing vagal predominance and inducing cough and
reflex bronchoconstriction (1,11,12). Terbutaline and
salbutamol (selective -2-adrenergic bronchodilator)
inhalation and effective suppression of cough response
from 43% to 3% support the concept of bronchoconstriction
(11). The rapid response of the reflex
and morphine’s efficacy in preventing cough suggests
that a pulmonary chemoreflex is also the likely mechanism
that is mediated by either irritant-receptors
(rapidly adapting receptors) or by vagal C fibers receptors
that are in proximity to pulmonary vessels
(juxta-capillary receptors), whereas suppression of
cough with inhaled betamethasone supports the trigger
stimulus and bronchial hyperirritability theory
(1,4,11). Histamine release from mast cells in the lungs
(though this seems unlikely because fentanyl rarely
causes histamine release), constriction of the tracheal
smooth muscles, and the possible stimulation of irritant
receptors after deformation of the tracheobronchial
wall triggering the cough are other plausible
explanations (1,2,13).
......
References
1 Agarwal A, Azim A, Ambesh S, et al. Salbutamol,
beclomethasone or sodium chromoglycate suppress
coughing induced by iv fentanyl. Can J Anesth 2003;
50: 297–300.
2 Tweed WA, Dakin D. Explosive coughing after bolus
fentanyl injection. Anesth Analg 2001; 92: 1442–3.
4 Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive
effect of a fentanyl bolus. Can J Anaesth 1991; 38:
330–4.
11 Pandey CK, Raza M, Ranjan R, et al. Intravenous
lidocaine suppresses fentanyl-induced coughing: a double-
blind, prospective, randomized placebo-controlled
study. Anesth Analg 2004; 99: 1696–8.
12 Lui PW, Hsing CH, Chu YC. Terbutaline inhalation
suppresses fentanyl-induced coughing. Can J Anaesth
1996; 43: 1216–9.
13 Yasuda I, Hirano T, Yusa T, Satoh M. Tracheal constriction
by morphine and by fentanyl in man.
Anesthesiology 1978: 49: 117–9.
14 Stellato C, Cirillo R, de Paulis A, et al. Human
basophil/mast cell releasability. IX. Heterogeneity of
the effects of opioids on mediator release.
Anesthesiology 1992; 77: 932–40.
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