Saturday, December 22, 2007

Saturday December 22, 2007
Re. Fentanyl Cough

Fentanyl is probably the most commonly used opioid in ICUs. Fentanyl is associated with coughing in upto 30% of patients. Usually its benign but may become explosive causing discomfort and increased intracranial and intra-ocular pressures. The various mechanisms proposed to explain fentanyl induced cough are inhibition of central sympathetic outflow leading to vagal predominance, histamine release or deformation of the tracheobronchial wall stimulating the irritant receptors.


Treatment is aerosol inhalation of Salbutamol, beclomethasone or sodium chromoglycate if needed.


References: click to get abstract / article

1.
Explosive coughing after bolus fentanyl injection. Anesth Analg 2001; 92: 1442–3.
2. Tussive effect of a fentanyl bolus administered through a central venous catheter. Anaesthesia 1990; 45: 18–21.
3.
Tussive effect of a fentanyl bolus. Can J Anaesth 1991; 38: 330–4
4.
Central vagal control of fentanyl-induced bradycardia during halothane anesthesia. Anesth Analg 1978; 57: 31–6
5.
Tracheal constriction by morphine and by fentanyl in man. Anesthesiology 1978; 49: 117–9.
6.
Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl Canadian Journal of Anesthesia 50:297-300 (2003)