Magnesium sulphate pretreatment obtunds fentanyl-induced cough during general anaesthesia induction
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Maaya, M., Masdar, A., Mahdi, S. N. M., Yusof, M., & Cheong, A. C. (2022). Magnesium sulphate pretreatment obtunds fentanyl-induced cough during general anaesthesia induction. Malaysian Journal of Anaesthesiology, 1(1), 12–22. https://doi.org/10.35119/myja.v1i1.12

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Copyright (c) 2022 Muhammad Maaya

Keywords

cough; fentanyl; general anaesthesia; magnesium sulphate

Abstract

Introduction: Fentanyl-induced cough is common during induction of general anaesthesia. This unpleasant cough may increase the intraocular, intracranial, and intraabdominal pressure. We hypothesised that 30 mg/kg of prophylactic intravenous magnesium sulphate is effective in obtunding 2 μg/kg fentanyl-induced cough.
Methods: One hundred and forty patients scheduled for general anaesthesia, aged between 18 to 70 years old with American Society of Anesthesiologists physical status I were randomised into two groups. Group I and Group II patients received 30 mg/kg intravenous magnesium sulphate and normal saline, respectively. The solution studied was infused over 15 minutes followed by a fentanyl bolus 2 μg/kg delivered within 3 seconds. The incidence of cough and severity were documented. Mean arterial pressure and heart rate were recorded every 5 minutes during the infusion.
Results: Eight patients (11.4%) had cough in Group II and one (1.4%) in Group I. Compared to Group II, the incidence and severity of cough were significantly lower in Group I (p = 0.003 and p = 0.037), respectively. There was no significant difference regarding the haemodynamic status between the two groups during the infusion of both solutions.
Conclusion: During general anaesthesia induction, 30 mg/kg of intravenous magnesium sulphate effectively obtunded fentanyl-induced cough.

 

https://doi.org/10.35119/myja.v1i1.12
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References

Katoh T, Ikeda K. The effects of fentanyl on sevoflurane requirements for loss of consciousness and skin incision. Anesthesiology. 1998;88(1):18-24. https://doi.org/10.1097/00000542-199801000-00006

Yoo KY, Lee JU, Kim HS, Im WM. Hemodynamic and catecholamine responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injuries. Anesthesiology. 2001;95(3):647-651. https://doi.org/10.1097/00000542-200109000-00017

Chen R, Tang LH, Sun T, et al. Mechanism and Management of Fentanyl-Induced Cough. Front Pharmacol. 2020;11:584177. https://doi.org/10.3389/fphar.2020.584177

El Motlb EA. Suppression of fentanyl-induced cough. A priming dose of intravenous dexmedetomidine–magnesium sulfate: A double blind, randomized, controlled study. Egyptian Journal of Anaesthesia. 2016;32(3):333-337. https://doi.org/10.1016/j.egja.2016.02.002

Benditt DG, Samniah N, Pham S, et al. Effect of cough on heart rate and blood pressure in patients with “cough syncope”. Heart Rhythm. 2005;2(8):807-813. https://doi.org/10.1016/j.hrthm.2005.04.022

Golmohammadi M, Shajiee S, Sane S, Valie M. Comparison of the effects of pretreatment intravenous fentanyl or intravenous lidocaine on suppression of fentanyl-induced cough in children: a randomized, double-blind, controlled clinical trial. Electron Physician. 2018;10(6):6877-6883. https://doi.org/10.19082/6877

Yeh CC, Wu CT, Huh BK, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth. 2007;19(1):53-56. https://doi.org/10.1016/j.jclinane.2006.05.021

Zhou W, Zhang D, Tian S, et al. Optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough suppression: a prospective randomized controlled trial. BMC Anesthesiol. 2019;19(1):89. https://doi.org/10.1186/s12871-019-0765-z

Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. 3rd ed. New Jersey: John Wiley & Sons; 2013.

Liu HL, An LJ, Su Z, Zhang Y, Gui B. Magnesium sulphate suppresses fentanyl-induced cough during general anesthesia induction: a double-blind, randomized, and placebo-controlled study. Int J Clin Exp Med. 2015;8(7):11332-11336.

Agarwal A, Azim A, Ambesh S, et al. Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl. Can J Anaesth. 2003;50(3):297-300. https://doi.org/10.1007/bf03017801

Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO. The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study. Paediatr Anaesth. 2003;13(1):43-47. https://doi.org/10.1046/j.1460-9592.2003.00927.x

Javor E, Grle SP. Limitations of the results from randomized clinical trials involving intravenous and nebulised magnesium sulphate in adults with severe acute asthma. Pulm Pharmacol Ther. 2019;55:31-37. https://doi.org/10.1016/j.pupt.2019.01.005

Han JI, Lee H, Kim CH, Lee GY. The frequency of fentanyl-induced cough in children and its effects on tracheal intubation. J Clin Anesth. 2010;22(1):3-6. https://doi.org/10.1016/j.jclinane.2009.01.019

Iida K, Handa M, Fukuda K, Saita N, Kasahara M, Koukita Y, et al. [Incidence and onset time of fentanyl-induced cough depends on the dose of IV fentanyl]. Masui. 2009;58(8):962-965.

Lin JA, Yeh CC, Lee MS, Wu CT, Lin SL, Wong CS. Prolonged injection time and light smoking decrease the incidence of fentanyl-induced cough. Anesth Analg. 2005;101(3):670-674. https://doi.org/10.1213/01.Ane.0000159161.31276.Db

Schäpermeier U, Hopf HB. Fentanyl-induced cough does not depend on injection speed: a randomized study. Acta Anaesthesiol Scand. 2008;52(8):1071-1075. https://doi.org/10.1111/j.1399-6576.2008.01721.x

Park SJ, Cho YJ, Oh JH, Hwang JW, Do SH, Na HS. Pretreatment of magnesium sulphate improves intubating conditions of rapid sequence tracheal intubation using alfentanil, propofol, and rocuronium - a randomized trial. Korean J Anesthesiol. 2013;65(3):221-227. https://doi.org/10.4097/kjae.2013.65.3.221

Almeida CED, Carvalho LR, Andrade CVC, Nascimento PD, Jr., Barros GAM, Modolo NSP. Effects of magnesium sulphate on the onset time of rocuronium at different doses: a randomized clinical trial. Braz J Anesthesiol. 2021;71(5):482-488. https://doi.org/10.1016/j.bjane.2021.07.023

Panda NB, Bharti N, Prasad S. Minimal effective dose of magnesium sulfate for attenuation of intubation response in hypertensive patients. J Clin Anesth. 2013;25(2):92-97. https://doi.org/10.1016/j.jclinane.2012.06.016

Jubairi HM, Eftekharian HR, Arabion HR. Intravenous Magnesium Sulfate to Deliberate Hypotension and Bleeding after Bimaxillary Orthognathic Surgery; A Randomized Double-blind Controlled Trial. J Dent (Shiraz). 2016;17(3 Suppl):276-282.

Mroczek WJ, Lee WR, Davidov ME. Effect of magnesium sulfate on cardiovascular hemodynamics. Angiology. 1977;28(10):720-724. https://doi.org/10.1177/000331977702801009

Wei JY, Harris WS. Heart rate response to cough. J Appl Physiol Respir Environ Exerc Physiol. 1982;53(4):1039-1043. https://doi.org/10.1152/jappl.1982.53.4.1039

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