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Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough

[L’administration iv de lidocaïne et d’éphédrine, mais non de propofol, supprime la toux causée par le fentanyl]

Chin-Shuang Lin, MD^*, Wei-Zen Sun, MD^*, Wei-Hung Chan, MD^*, Chen-Jung Lin, MD^*, Huei-Ming Yeh, MD^* and Martin S. Mok, MD

^* From the Departments of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, and
the Taipei Medical University Hospital, Taipei, Taiwan.

Address correspondence to: Dr. Wei-Hung Chan, Department of Anesthesiology, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei, Taiwan, 100. Phone: +886-2-23123456, ext. 5519; Fax: +886-2-23415736; E-mail: andrchan{at}ms34.hinet.net

Purpose: The aim of this study was to evaluate the effectiveness of lidocaine, propofol and ephedrine in suppressing fentanyl-induced cough.

Methods: One hundred and eighteen patients were randomly assigned into four groups and the following medications were given intravenously: patients in Group I (n = 31) received normal saline 2 mL, Group II (n = 29) received lidocaine 2 mg·kg^–1, Group III (n = 30) received propofol 0.6 mg·kg^–1 and Group IV (n = 28) received ephedrine 5 mg. At one minute after the study medication, fentanyl 2.5 µg·kg^–1 was given intravenously within two seconds. The occurrence of cough and vital sign profiles were recorded within two minutes after fentanyl bolus by an anesthesiologist blinded to study design.

Results: Sixty-five percent of patients in the placebo group had cough, whereas the frequency was significantly decreased in Groups II (14%) and IV (21%). Although a numerically lower frequency of cough was noted in Group III (37%), it was not statistically different from that of the placebo group. SpO₂ decreased significantly in patients of Group III compared to placebo; one patient experienced hypoxemia necessitating mask ventilation. Patients in Group III showed a decrease in heart rate and systolic blood pressure (2 beats·min^–1 and 8 mmHg vs baseline). Patients in Group IV showed an increase in both measurements (5 beats·min^–1 and 8 mmHg vs baseline). No truncal rigidity was observed throughout the study.

Conclusions: Intravenous lidocaine 2 mg·kg^–1 or ephedrine 5 mg, but not propofol 0.6 mg·kg^–1, was effective in preventing fentanyl-induced cough. The results provide a convenient method to decrease fentanyl-induced cough.

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