Shen Jin-Chun, Xu Jian-Guo, Zhou Zhi-Qiang, Liu Hong-Jun, Yang Jian-Jun
Department of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China.
Curr Ther Res Clin Exp. 2008 Dec;69(6):480-7. doi: 10.1016/j.curtheres.2008.12.002.
Fentanyl congeners have been found to induce cough during induction of general anesthesia. Studies of fentanyl and sufentanil have found incidence rates of 28% to 65% and 15%, respectively. However, no study has assessed the occurrence of cough induced by remifentanil.
The aim of this study was to assess the effect of equivalent doses of fentanyl, sufentanil, and remifentanil on cough.
Patients rated American Society of Anesthesiologists class I or II of either sex, aged 18 to 60 years, who were scheduled for elective abdominal surgery with general anesthesia were randomly and equally assigned to 3 groups using a computer-generated table of random numbers. The patients received equivalent doses of fentanyl 2 μg/kg, sufentanil 0.2 μg/kg, or remifentanil 2 μg/kg via IV push. Vital signs (systolic blood pressure [SBP], heart rate [HR], and oxygen saturation via pulse oximetry [SpO2]) and the occurrence and severity of cough were recorded for 2 minutes after drug administration by an anesthesiologist who was blinded to the drug treatment. The severity of cough was graded as none (0), mild (1-2), moderate (3-5), or severe (>5).
A total of 315 Chinese patients (197 women, 118 men; mean [SD] age, 37.9 [10.4] years) were approached for enrollment and assigned to 3 groups of 105 patients each; all patients completed the study protocol. The 3 treatment groups were similar in terms of demographic characteristics and type of abdominal surgery. The incidence of cough was significantly greater in the remifentanil group (57 [54.3%] patients) than in the fentanyl group (35 [33.3%]; P < 0.01) or the sufentanil group (32 [30.5%]; P < 0.01). The severity of cough was significantly greater in the remifentanil group (severe, moderate, mild, none: 24, 7, 26, 48) than in the fentanyl (7, 9, 19, 70; P < 0.01) or sufentanil group (4, 2, 26, 73; P < 0.01). In all 3 groups, when the patients coughed, significant increases were observed in their SBP (128 [12]-139 [16] mm Hg; P < 0.01) and HR (74 [10]-87 [16] beats/min; P < 0.01). Within 2 minutes after drug administration, 62 patients (59%) in the remifentanil group experienced hypoxemia (SpO2 <90%) necessitating manually assisted mask ventilation, while no patients experienced hypoxemia in the fentanyl or sufentanil group. Three patients (2.9%) in the remifentanil group experienced muscle rigidity and deterioration of SBP, HR, and SpO2. No other adverse events were recorded. Cunclusion: Remifentanil was associated with a significantly greater incidence and severity of cough than equivalent doses of fentanyl or sufentanil. Fentanyl and sufentanil appeared comparable in these Chinese patients undergoing abdominal surgery.
研究发现芬太尼同系物在全身麻醉诱导期间可引发咳嗽。对芬太尼和舒芬太尼的研究发现其发生率分别为28%至65%和15%。然而，尚无研究评估瑞芬太尼诱发咳嗽的情况。
本研究旨在评估等效剂量的芬太尼、舒芬太尼和瑞芬太尼对咳嗽的影响。
将计划接受全身麻醉下择期腹部手术、年龄18至60岁、美国麻醉医师协会分级为I或II级的患者，通过计算机生成的随机数字表随机均分为3组。患者经静脉推注接受等效剂量的芬太尼2μg/kg、舒芬太尼0.2μg/kg或瑞芬太尼2μg/kg。由对药物治疗不知情的麻醉医师在给药后2分钟记录生命体征（收缩压[SBP]、心率[HR]和经脉搏血氧饱和度仪测定的血氧饱和度[SpO2]）以及咳嗽的发生情况和严重程度。咳嗽严重程度分为无（0级）、轻度（1 - 2级）、中度（3 - 5级）或重度（>5级）。
共纳入315例中国患者（女性197例，男性118例；平均[标准差]年龄37.9[10.4]岁）并随机分为3组，每组105例；所有患者均完成研究方案。3个治疗组在人口统计学特征和腹部手术类型方面相似。瑞芬太尼组咳嗽发生率（57例[54.3%]）显著高于芬太尼组（35例[33.3%]；P<0.01）或舒芬太尼组（32例[30.5%]；P<0.01）。瑞芬太尼组咳嗽严重程度（重度、中度、轻度、无：24、7、26、48）显著高于芬太尼组（7、9、19、70；P<0.01）或舒芬太尼组（4、2、26、73；P<0.01）。在所有3组中，患者咳嗽时，其SBP（128[12] - 139[16]mmHg；P<0.01）和HR（74[10] - 87[16]次/分钟；P<0.01）均显著升高。给药后2分钟内，瑞芬太尼组62例患者（59%）出现低氧血症（SpO2<90%），需要面罩人工辅助通气，而芬太尼组和舒芬太尼组无患者出现低氧血症。瑞芬太尼组3例患者（2.9%）出现肌肉强直以及SBP、HR和SpO2恶化。未记录到其他不良事件。结论：与等效剂量的芬太尼或舒芬太尼相比，瑞芬太尼引发咳嗽的发生率和严重程度显著更高。在这些接受腹部手术的中国患者中，芬太尼和舒芬太尼的效果似乎相当。
