Department of Anaesthesiology, The First People's Hospital of Hefei, Anhui Medical University, Huaihe Road 390, Hefei 230061, China.
Ir J Med Sci. 2012 Dec;181(4):517-20. doi: 10.1007/s11845-012-0807-8. Epub 2012 Feb 29.
The incidence of fentanyl-induced cough (FIC) occurs frequently during induction of general anesthesia, and methods to prevent it are needed. In this study, we hypothesized that premedication with intravenous dexmedetomidine-midazolam can suppress FIC effectively.
A total of 440 patients of ASA I or II, aged 18-65 years, weighing 41-90 kg, undergoing elective surgery were randomized into four groups of 110 each, using computer-generated random numbers. Group S + S: normal saline 0.15 ml/kg + normal saline 0.06 ml/kg; Group S + M: normal saline 0.15 ml/kg + midazolam 0.06 mg/kg; Group D + S: dexmedetomidine 0.6 μg/kg + normal saline 0.06 ml/kg; Group D + M: dexmedetomidine 0.6 μg/kg + midazolam 0.06 mg/kg. After receiving the above-mentioned drugs, all patients received i.v. fentanyl (3 μg/kg). After fentanyl administration, the onset time and the severity of cough for 1 min were recorded. Severity of coughing was graded as mild (1-2), moderate (3-5) and (>5) based on the number of cough per minute.
Forty-five (40.9%) patients had cough in Group S + S, 70 (63.6%) in Group S + M and 25 (22.7%) in Group D + S. None of the patients in Group D + M had any cough. The total incidence of cough was significantly higher (P < 0.01) in Group S + M in comparison to that in other groups. The onset time of cough was significantly shorter in Group S + M (13.8 ± 3.8 s) than in Group S + S (18.7 ± 3.9 s, P < 0.01) or Group D + S. (18.2 ± 3.2 s, P < 0.01). However, there was no significant difference among groups in cough severity.
Pretreatment with dexmedetomidine-midazolam could completely suppress FIC caused by fentanyl 3 μg/kg injection within 2 s.
芬太尼诱导咳嗽（FIC）在全身麻醉诱导期间经常发生，需要寻找预防方法。本研究假设静脉给予右美托咪定-咪达唑仑预处理可以有效抑制 FIC。
选择 ASA 分级Ⅰ或Ⅱ级，年龄 18-65 岁，体重 41-90kg，择期手术患者 440 例，采用计算机产生的随机数字分为四组，每组 110 例。S+S 组：生理盐水 0.15ml/kg+生理盐水 0.06ml/kg；S+M 组：生理盐水 0.15ml/kg+咪达唑仑 0.06mg/kg；D+S 组：右美托咪定 0.6μg/kg+生理盐水 0.06ml/kg；D+M 组：右美托咪定 0.6μg/kg+咪达唑仑 0.06mg/kg。给予上述药物后，所有患者均静脉注射芬太尼（3μg/kg）。芬太尼给药后记录咳嗽发作时间和 1min 内咳嗽严重程度。根据每分钟咳嗽次数将咳嗽严重程度分为轻度（1-2）、中度（3-5）和（>5）。
S+S 组 45 例（40.9%）、S+M 组 70 例（63.6%）、D+S 组 25 例（22.7%）患者发生咳嗽，D+M 组患者无咳嗽。S+M 组咳嗽总发生率明显高于其他组（P<0.01）。S+M 组咳嗽发作时间明显短于 S+S 组（13.8±3.8s）和 D+S 组（18.2±3.2s，P<0.01）。但三组咳嗽严重程度差异无统计学意义。
右美托咪定-咪达唑仑预处理可在 2s 内完全抑制 3μg/kg 芬太尼注射引起的 FIC。
