Mukherjee Avik, Kundu Asim Kumar, Ghosh Sudipta, Choudhuri Rajat, Bandopadhyay Bijoy Kumar, Dasgupta Sugata
Department of Anaesthesiology, R.G. Kar Medical College, Kolkata, India.
J Anaesthesiol Clin Pharmacol. 2011 Oct;27(4):489-94. doi: 10.4103/0970-9185.86593.
Fentanyl-induced cough is not always benign and brief and can be remarkably troublesome, spasmodic, and explosive. Dextromethorphan, an opioid derivative with an antitussive action, may be effective in reducing the fentanyl-induced cough. Dextromethorphan, a N-methyl D aspartate receptor antagonist, may have some effect on diminishing the stress response to surgery. This study was undertaken to determine whether preoperative dextromethorphan could effectively attenuate its incidence, severity, and effect on postoperative stress hormone levels.
Three hundred and twenty patients of American society of anesthesiologists I-II, aged 18-60 years, undergoing elective laparoscopic cholecystectomy or appendicectomy were randomly allocated into two groups (Group C, control; Group D, dextromethorphan) consisting of 160 patients each. Patients in Group D received dextromethorphan 40 mg orally and in Group C received placebo tablets 60 minutes before induction of anesthesia. The incidence of cough was recorded for 1 minute after fentanyl injection and graded as none (0), mild (1-2), moderate (3-5), and severe (>5 cough). Blood samples were collected for estimation of stress hormone levels before surgery and again at 1 hour and 24 hours postoperatively and compared. The appearance of adverse reactions was recorded.
The incidence of reflex fentanyl cough was lower in dextromethorphan group (3.9%) in comparison to placebo (59.8%). Five patients developed mild and one moderate cough in the dextromethorphan group. In the control group, 31 patients developed mild, 29 moderate, and 32 severe cough. The stress hormones were significantly higher at 1 hour and 24 hours postoperatively in both groups in comparison to its preoperative values. However, at 1 hour postoperatively, adrenocorticotropic hormone, epinephrine, and growth hormone values were significantly low in the dextromethorphan group (61.5 ± 21.1 pg/ ml, 142.1 ± 11.2 pg/ml, and 3.8 ± 0.7 ng/ml) relative to the control group (73.4 ± 21.9 pg/ml, 158.9 ± 17.9 pg/ml, and 4.2 ± 1.3 ng/ml), but changes became insignificant at 24 hours postoperatively.
Preoperative oral dextromethorphan 40 mg decreased the incidence and severity of fentanyl induced cough and reduced the rise in stress hormones at 1 hour postoperatively.
芬太尼诱发的咳嗽并非总是良性且短暂的，可能会非常麻烦、呈痉挛性且剧烈。右美沙芬是一种具有镇咳作用的阿片类衍生物，可能对减轻芬太尼诱发的咳嗽有效。右美沙芬作为一种N-甲基-D-天冬氨酸受体拮抗剂，可能对减轻手术应激反应有一定作用。本研究旨在确定术前使用右美沙芬是否能有效降低其发生率、严重程度以及对术后应激激素水平的影响。
320例年龄在18至60岁、美国麻醉医师协会分级为I-II级、接受择期腹腔镜胆囊切除术或阑尾切除术的患者被随机分为两组（C组，对照组；D组，右美沙芬组），每组160例。D组患者在麻醉诱导前60分钟口服40毫克右美沙芬，C组患者服用安慰剂片。记录芬太尼注射后1分钟内的咳嗽发生率，并分为无（0级）、轻度（1-2级）、中度（3-5级）和重度（>5次咳嗽）。在手术前、术后1小时和24小时采集血样以测定应激激素水平并进行比较。记录不良反应的出现情况。
与安慰剂组（59.8%）相比，右美沙芬组（3.9%）反射性芬太尼咳嗽的发生率较低。右美沙芬组有5例患者出现轻度咳嗽，1例出现中度咳嗽。在对照组中，31例患者出现轻度咳嗽，29例出现中度咳嗽，32例出现重度咳嗽。与术前值相比，两组术后1小时和24小时的应激激素水平均显著升高。然而，术后1小时，右美沙芬组的促肾上腺皮质激素、肾上腺素和生长激素值（分别为61.5±21.1皮克/毫升、142.1±11.2皮克/毫升和3.8±0.7纳克/毫升）相对于对照组（分别为73.4±21.9皮克/毫升、158.9±17.9皮克/毫升和4.2±1.3纳克/毫升）显著降低，但术后24小时差异不显著。
术前口服40毫克右美沙芬可降低芬太尼诱发咳嗽的发生率和严重程度，并降低术后1小时应激激素的升高。
