Department of Anaesthesiology and Pain Medicine, Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Acta Anaesthesiol Scand. 2011 Nov;55(10):1215-20. doi: 10.1111/j.1399-6576.2011.02529.x. Epub 2011 Sep 26.
Although fentanyl suppresses tracheal tube-induced cough during anesthetic recovery, it has not been proven if its antitussive effect is dose dependent and complication free. The purpose of this study is to evaluate the relationship between fentanyl doses and cough suppression during emergence from sevoflurane anesthesia.
Sixty patients undergoing thyroidectomy were randomly allocated to one of four groups (F0, F1, F1.5, and F2) according to the fentanyl dose (0 mcg/kg, 1 mcg/kg, 1.5 mcg/kg, or 2 mcg/kg). Fentanyl was administered immediately after sevoflurane discontinuation. Coughing was assessed throughout the periextubation period. The relationship between fentanyl dose and incidence of cough was analyzed using Cochran-Armitage trend test. Incidence of more than 30% elevation of mean arterial pressure (MAP) and heart rate (HR), awakening time, extubation time, and respiratory rate after extubation were recorded and compared using Mantel-Haenszel chi-square test and one-way analysis of variance.
Fentanyl suppressed emergence cough in a dose-related manner (P = 0.002), and the ED(50) and ED(90) were 1.1 mcg/kg and 2.1 mcg/kg, respectively. The higher dose of fentanyl further reduced the number of patient with MAP and HR elevation (P = 0.003 and 0.005, respectively). Awakening time (8.4 ± 1.9 min) in F2 was comparable with that in F1 and F1.5. Respiratory rate (9 ± 2 bpm) and extubation time (11.9 ± 1.8 min) in F2 were only different from those in F0 (13 ± 3 bpm and 10.4 ± 1.1 min, respectively).
Fentanyl suppressed cough in a dose-related manner during recovery from general sevoflurane anesthesia, and 2 mcg/kg may be considered as a proper dose.
芬太尼在麻醉恢复期抑制气管导管引起的咳嗽，但尚未证明其镇咳作用是否与剂量有关且无并发症。本研究旨在评估芬太尼剂量与七氟醚麻醉苏醒期咳嗽抑制之间的关系。
60 例行甲状腺切除术的患者根据芬太尼剂量（0mcg/kg、1mcg/kg、1.5mcg/kg 或 2mcg/kg）随机分为四组（F0、F1、F1.5 和 F2）。芬太尼在七氟醚停药后立即给予。在整个拔管期评估咳嗽情况。采用 Cochran-Armitage 趋势检验分析芬太尼剂量与咳嗽发生率的关系。记录并比较平均动脉压（MAP）和心率（HR）升高超过 30%、苏醒时间、拔管时间和拔管后呼吸频率的发生率，采用 Mantel-Haenszel χ2 检验和单向方差分析。
芬太尼呈剂量依赖性抑制苏醒性咳嗽（P=0.002），ED50 和 ED90 分别为 1.1mcg/kg 和 2.1mcg/kg。较高剂量的芬太尼进一步减少了 MAP 和 HR 升高的患者数量（P=0.003 和 0.005）。F2 组的苏醒时间（8.4±1.9min）与 F1 和 F1.5 组相似。F2 组的呼吸频率（9±2bpm）和拔管时间（11.9±1.8min）仅与 F0 组不同（分别为 13±3bpm 和 10.4±1.1min）。
芬太尼在全身七氟醚麻醉恢复期呈剂量依赖性抑制咳嗽，2mcg/kg 可作为适当剂量。
