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Identification of independent risk factors for fentanyl-induced cough

[L’identification de facteurs de risque indépendants pour la toux induite par le fentanyl]

From the Department of Anesthesia, Gifu University School of Medicine, Gifu-City, Gifu, Japan.

Address correspondence to: Dr. Tsutomu Oshima, Department of Anesthesia, Teikyo University School of Medicine Ichihara Hospital, 3426-3 Anesaki, Ichihara, Chiba 299-0111, Japan. Phone: 81-436-62-1211; Fax: 81-436-62-2621; E-mail: oshimat{at}med.teikyo-u.ac.jp

Purpose: To determine how the probability of fentanyl-induced cough is affected by patient characteristics and/or anesthetic technique.

Methods: We analyzed data from a cohort of 1,311 adult patients undergoing elective surgery under general anesthesia, accompanied by iv fentanyl. The following data were collected: patient demographics, history of cigarette smoking, presence of bronchial asthma or chronic obstructive pulmonary disease, administration of angiotensin converting enzyme inhibitors; and anesthetic technique, including: preanesthetic anxiolytic medication, prior use of atropine, epidural lidocaine, a priming dose of vecuronium, and the dose of iv fentanyl. Associations between individual variables in the clinical evaluation model and the likelihood of fentanyl-induced cough were characterized by calculating odds ratios. Multiple logistic regression analysis was used to examine the independent contribution of each variable while controlling for all variables.

Results: Fentanyl-induced cough was independently associated with the following: aging, cigarette smoking, a prior epidural injection of lidocaine, and a priming dose of vecuronium. Fentanyl-induced cough was unaffected by gender, the presence of either bronchial asthma or chronic obstructive pulmonary disease, or prior use of atropine.

Conclusions: Fentanyl-induced cough may be suppressed by aging, cigarette smoking, prior epidural injection of lidocaine, or a priming dose of vecuronium. These findings may allow insights into the mechanism of this phenomenon, thereby leading to its prevention.