Sako Saori, Tokunaga Shoji, Tsukamoto Masanori, Yoshino Jun, Fujimura Naoyuki, Yokoyama Takeshi
Department of Dental Anesthesiology, Faculty of Dental Science, Kyushu University, 3-1-1 Maidashi higashi-ku, Fukuoka, 812-8582, Japan.
Medical Information Center, Kyushu University Hospital, Fukuoka, Japan.
J Anesth. 2017 Apr;31(2):212-218. doi: 10.1007/s00540-016-2300-4. Epub 2017 Jan 3.
Fentanyl is a strong µ-opioid analgesic which attenuates the stimulation of surgical invasion and tracheal intubation. However, intravenous fentanyl often induces coughing [fentanyl-induced coughing (FIC)] during induction of anesthesia. We found that the swallowing action, when requested at induction of anesthesia, attenuated FIC. In the current study, we investigated the relationship between the occurrence of FIC and the swallowing action.
The study included American Society of Anesthesiologists physical status I or II patients, aged 20-64 years, who were undergoing elective surgery. They were divided into two groups-one group was urged to perform the swallowing action immediately before intravenous fentanyl (S group), and the other group performed no swallowing action (non-S group). The patients first received intravenous fentanyl and were observed for 90 s. Each patient's background, dose of fentanyl and occurrence of coughing were investigated from their records and a motion picture recording. The incidence of FIC was evaluated by chi-squared test, and severity was tested by Wilcoxon rank-sum test. P < 0.05 was considered statistically significant.
The incidence of FIC in the S group and non-S group was 14.0 and 40.4%, respectively. The risk of FIC was reduced in the S group by 75%; risk ratio (95% confidence interval) was 0.35 (0.20, 0.60). The number of coughs in the S group were less than in the non-S group (P < 0.001).
The swallowing action immediately before intravenous fentanyl may be a simple and clinically feasible method for preventing FIC effectively. Clinical trial number: UMIN000012086 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=Rn000014126&language=J ).
芬太尼是一种强效μ阿片类镇痛药，可减轻手术侵袭和气管插管的刺激。然而，静脉注射芬太尼在麻醉诱导期间常诱发咳嗽[芬太尼诱发咳嗽（FIC）]。我们发现，在麻醉诱导时要求进行吞咽动作可减轻FIC。在本研究中，我们调查了FIC的发生与吞咽动作之间的关系。
本研究纳入了年龄在20 - 64岁、美国麻醉医师协会身体状况为I或II级、正在接受择期手术的患者。他们被分为两组——一组在静脉注射芬太尼前立即被催促进行吞咽动作（S组），另一组不进行吞咽动作（非S组）。患者首先接受静脉注射芬太尼，并观察90秒。从他们的记录和动态录像中调查每位患者的背景、芬太尼剂量和咳嗽发生情况。FIC的发生率通过卡方检验进行评估，严重程度通过Wilcoxon秩和检验进行测试。P < 0.05被认为具有统计学意义。
S组和非S组FIC的发生率分别为14.0%和40.4%。S组FIC的风险降低了75%；风险比（95%置信区间）为0.35（0.20，0.60）。S组的咳嗽次数少于非S组（P < 0.001）。
静脉注射芬太尼前立即进行吞咽动作可能是一种简单且临床可行的有效预防FIC的方法。临床试验编号：UMIN000012086（https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=Rn000014126&language=J）。
