Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis.

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.