The Effect of Ketamine and Dexamethasone on Frequency and Intensity of Fentanyl-Induced Cough

Document Type : Original Article (s)

Authors

1 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Intravenous (IV) administration of fentanyl during induction of general anesthesia often elicits cough, with frequency of 18% to 80%. Therefore, in this study, we aimed to compare the effects of ketamine and dexamethasone on decreasing cough in patients undergoing general anesthesia with fentanyl.Methods: During a double-blind randomized clinical trial study, 99 patients aged 18-64 years with class I and II based on the scale of American Society of Anesthesiologists (ASA) who were undergoing general anesthesia with fentanyl were investigated. Patients were randomly divided equally into 3 groups receiving ketamine (0.5 mg/kg), dexamethasone (0.1 mg/kg), and placebo (5 ml normal saline). All drugs were administered 1 minute before administration of 2.5 µg/kg fentanyl. Vital signs, and frequency and intensity of cough were measured and recorded. Statistical analysis was performed using one-way ANOVA and Kruskal-Wallis tests.Findings: The frequency of cough was significantly lower in the ketamine group (81.8%) compared with dexamethasone (90.9%) and placebo (93.1%) groups (P = 0.03). The intensity of cough was significantly lower in the ketamine group (mild: 18.2%; moderate: 78.8%; severe: 3.0%) compared with placebo group (mild: 9.1%, moderate: 72.7%; severe: 18.2%) (P = 0.04). Furthermore, there were significant differences between the three groups in variations of systolic blood pressure, diastolic blood pressure, and heart rate (P < 0.05 for all).Conclusion: Administration of low-dose ketamine can effectively reduce frequency and intensity of fentanyl-induced cough during anesthesia in patients undergoing general anesthesia.

Keywords


  1. 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.
  2. Wang K, Milojevic N, Sheinman B, Usmani OS. Cough management in primary, secondary and tertiary settings. Pulm Pharmacol Ther 2017; 47: 93-8.
  3. 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(2): 257-66.
  4. Song WJ, Morice AH. Cough hypersensitivity syndrome: A few more steps forward. Allergy Asthma Immunol Res 2017; 9(5): 394-402.
  5. El Baissari MC, Taha SK, Siddik-Sayyid SM. Fentanyl-induced cough--pathophysiology and prevention. Middle East J Anaesthesiol 2014; 22(5): 449-56.
  6. Du BX, Cao L, Zhao WL, Xu ZH, Song J, Shi XY. Pre-emptive small dose of fentanyl suppresses fentanyl-induced cough: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2014; 7(4): 826-36.
  7. Rajan S, Malayil GJ, Varghese R, Kumar L. Comparison of usefulness of ketamine and magnesium sulfate nebulizations for attenuating postoperative sore throat, hoarseness of voice, and cough. Anesth Essays Res 2017; 11(2): 287-93.
  8. Hendaus MA, Jomha FA, Alhammadi AH. Is ketamine a lifesaving agent in childhood acute severe asthma? Ther Clin Risk Manag 2016; 12: 273-9.
  9. Lin JA, Chen FC, Lee MS, Horng HC, Cherng CH, Yeh CC, et al. Intravenous dexamethasone pretreatment reduces fentanyl-induced cough. J Formos Med Assoc 2007; 106(8): 649-55.
  10. Yu MS, Kim JY, Kim HY. Intravenous dexamethasone pretreatment reduces remifentanil induced cough. Korean J Anesthesiol 2011; 60(6): 403-7.
  11. Agarwal A, Azim A, Ambesh S, Bose N, Dhiraj S, Sahu D, et al. Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl. Can J Anaesth 2003; 50(3): 297-300.
  12. Stanley TH. The fentanyl story. J Pain 2014; 15(12): 1215-26.
  13. Yeh CC, Wu CT, Huh BK, Lee MS, Lin SL, Sheen J, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth 2007; 19(1): 53-6.
  14. Guler G, Aksu R, Bicer C, Tosun Z, Boyaci A. Comparison of the effects of ketamine or lidocaine on fentanyl-induced cough in patients undergoing surgery: A prospective, double-blind, randomized, placebo-controlled study. Curr Ther Res Clin Exp 2010; 71(5): 289-97.
  15. 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(4): 333-7.