Authors
Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: The injection of remifentanil can cause cough during induction of anesthesia. This study was designed to examine the efficacy of ketamine, dexamethasone, and their combination on remifentanil-induced cough (RIC).
Materials and Methods: One hundred and twenty patients scheduled for elective surgery were randomly assigned into four groups: Group K received 10 mg ketamine; Group D received 10 mg dexamethasone; Group KD received 10 mg ketamine in combination with dexamethasone; and Group S received saline in a similar volume, five minutes prior to the injection of remifentanil. The incidence and severity of the cough was recorded in each person.
Results: The incidence of RIC was significantly lower in Group KD compared to Group K, Group D, and Group S (3.3 vs. 20%, 20%, and 46.7%, respectively, P < 0.05).The severity of RIC was significantly lower in Group KD compared to Group K, Group D, and Group S (P < 0.05). There was no significant difference between Group K and Group D in this regard (P > 0.05). There was no significant difference in the onset time of coughing among the four groups (19.8 ± 1.3, 20.8 ± 0.9, 19.0 ± 1.1, and 19.9 ± 2.2 in Group K, Group D, Group KD, and Group S, respectively, P > 0.05).
Conclusion: We found that pretreatment with 10 mg ketamine in combination with 10 mg dexamethasone five minutes prior to the injection of remifentanil could significantly reduce the incidence of RIC, and it was better than using each drug singly.
Keywords
1. | Kim JY, Lee SY, Kim DH, Park SK, Min SK. Effect-site concentration of propofol for reduction of remifentanil-induced cough. Anaesthesia 2010;65:697-703. [PUBMED] |
2. | Cho HB, Kwak HJ, Park SY, Kim JY. Comparison of the incidence and severity of cough after alfentanil and remifentanil injection. Acta Anaesthesiol Scand 2010;54:717-20. [PUBMED] |
3. | Tweed WA, Dakin D. Explosive coughing after bolus fentanyl injection. Anesth Analg 2001;92:1442-3. [PUBMED] |
4. | Lui PW, Hsing CH, Chu YC. Terbutaline inhalation suppresses fentanyl-induced coughing. Can J Anaesth 1996;43:1216-9. [PUBMED] |
5. | 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;50:297-300. |
6. | Lin CS, Sun WZ, Chan WH, Lin CJ, Yeh HM, Mok MS. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl induced cough. Can J Anaesth 2004;51:654-9. [PUBMED] |
7. | Yu MS, Kim JY, Kim HY. Intravenous dexamethasone pretreatment reduces remifentanil-induced cough. Korean J Anesthesiol 2011;60:403-7. [PUBMED] |
8. | Pandey CK, Raza M, Ranjan R, Lakra A, Agarwal A, Singh U, et al. Intravenous lidocaine suppresses fentanyl-induced coughing: A double-blind, prospective, randomized placebo-controlled study. Anesth Analg 2004;99:1696-8. [PUBMED] |
9. | Yeh CC, Wu CT, Huh BK, Lee MS, Lin SL, Sheen MJ, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth 2007;19:53-6. |
10. | Reitan JA, Stengert KB, Wymore ML, Martucci RW. Central vagal control of fentanyl-induced bradycardia during halothane anesthesia. Anesth Analg 1978;57:31-6. [PUBMED] |
11. | Paintal AS. Mechanism of stimulation of type J pulmonary receptors. J Physiol 1969;203:11-32. |
12. | Bohrer H, Fleischer F, Werning P. Tussive effect of a fentanyl bolus administered through a central venous catheter. Anaesthesia 1990;45:18-21. |
13. | Horng HC, Wong CS, Hsiao KN, Huh BK, Kuo CP, Cherng CH, et al. Pre-medication with intravenous clonidine suppresses fentanyl-induced cough. Acta Anaesthesiol Scand 2007;51:862-5. |
14. | Yasuda I, Hirano T, Yusa T, Satoh M. Tracheal constriction by morphine and by fentanyl in man. Anesthesiology 1978;49:117-9. [PUBMED] |
15. | Said SI, Berisha HI, Pakbaz H. N-Methyl-d-aspartate receptors outside the central nervous system: Activation causes acute lung injury that is mediated by nitric oxide synthesis and prevented by vasoactive intestinal peptide. Neuroscience 1995;65:943-6. [PUBMED] |
16. | Sato T, Hirota K, Matsuki A, Zsigmond EK, Rabito SF. The role of the N-methyl-d-aspartate receptor in the relaxant effect of ketamine on tracheal smooth muscle. Anesth Analg 1998;87:1383-8. [PUBMED] |
17. | Robertson BS, Satterfield BE, Said SI, Dey RD. N-Methyl-d-aspartate receptors are expressed by intrinsic neurons of rat larynx and esophagus. Neurosci Lett 1998;244:77-80. [PUBMED] |
18. | Cheng EY, Mazzeo AJ, Bosnjak ZJ, Coon RL, Kampine JP. Direct relaxant effects of intravenous anesthetics on airway smooth muscle. Anesth Analg 1996;83:162-8. [PUBMED] |
19. | Kamei J, Tanihara H, Igarashi H, Kasuya Y. Effects of N-methyl-daspartate antagonists on the cough. Eur J Pharmacol 1989;168:153-8. [PUBMED] |
20. | Durieux ME. Inhibition by ketamine of muscarinic acetylcholine receptor function. Anesth Analg 1995;81:57-62. [PUBMED] |
21. | Krumins SA, Broomfield CA. Evidence of NK1 and NK2 tachykinin receptors and their involvement in histamine release in a murine mast cell line. Neuropeptides 1992;21:65-72. [PUBMED] |
22. | Murlas CG, Lang Z, Williams GJ, Chodimella V. Aerosolized neutral endopeptidase reverses ozone-induced airway hyperreactivity to substance P. J Appl Physiol 1992;72:1133-41. [PUBMED] |
23. | Lang Z, Murlas CG. Neutral endopeptidase of a human airway epithelial cell line recovers after hypochlorous acid exposure: Dexamethasone accelerates this by stimulating neutral endopeptidasem RNA synthesis. Am J Respir Cell Mol Biol 1992;7:300-6. [PUBMED] |
24. | Fraser CM, Venter JC. The synthesis of beta-adrenergic receptors in cultured human lung cells: Induction by glucocorticoids. Biochem Biophys Res Commun 1980;94:390-7. [PUBMED] |
25. | Murlas CG, Lang Z, Chodimella V. Dexamethasone reduces tachykinin but not ACh airway hyperreactivity after O3. Lung 1993;171:109-21. [PUBMED] |
26. | Tournoy KG, De Swert KO, Leclere PG, Lefebvre RA, Pauwels RA, Joos GF. Modulatory role of tachykinin NK1 receptor in cholinergic contraction of mouse trachea. Eur Respir J 2003;21:3-10. [PUBMED] |