Report an error   

Submitted: 02 October 2013 Modified: 02 October 2013
HERDIN Record #: R07-CVHRDC-13100211113938

A comparative study on lidocaine, ketamine and propofol in suppressing fentanyl-induced cough on patients undergoing elective surgical procedures in Vicente Sotto Memorial Medical Center.

Jalilah S. Mutia-Bato,
Fay Jasmine Delos Santos

See More

BACKGROUND: Opioids are used to allay anxiety and to decrease pain associated with surgery. Fentanyl is commonly used as a pre-induction adjunct because of its quick onset, short duration of action, intense analgesia, cardiovascular stability, and low histamine release, but a pre-induction bolus dose of fentanyl elicits cough. Although various mechanisms responsible for opioid-induced cough have been postulated, the exact mechanism is still unclear. This study aims to find other drugs that could effectively attenuate fentanyl-induced cough while being convenient in clinical practice.

METHOD: One hundred and seventeen patients were randomly assigned into four groups and the following medications were given intravenously; patients in Group I ( n= 31) received normal saline 2 ml, Group II ( n= 29) received lidocaine 2 mg/kg, Group III ( n= 30) received propofol 0.6 mg/kg and Group IV (n- 28) received ketamine 0.1 mg/kg. At one minute after the study medication, fentanyl 2.0 ug/kg was given intravenously within two seconds. The occurrence of cough and vital sign profiles were recorded within two minutes after fentanyl bolus by an anesthesiologists blinded to study design.

RESULT: Seventy-five percent of patients in the placebo group had cough, whereas the frequency was significantly decreased in Groups II (16.6%) and IV (25%). Although a numerically lower frequency of cough was noted in Group III (40%), it was not statistically different from that of the placebo group. Sp02 decreased significantly in patients of Group III compared to placebo; one patient experienced hypoxemia necessitating mask ventilation. Patients in Group III showed a decrease in heart rate and systolic blood pressure. Patients in Group IV showed an increase in both measurement. No truncal rigidity was observed throughout the study.

CONCLUSION: In conclusion, our result has demonstrated that IV lidocaine 2.0 mg/kg, when administered one minute before fentanyl, is an effective and clinically feasible method for suppressing fentanyl-induced cough without possible systemic lidocaine toxicity and without affecting the severity of the cough. And ketamine 0.1 mg/kg can be alternative in suppressing fentanyl induced cough when given intravenously. On the other hand, propofol at the dose of 0.6 mg/kg is ineffective for the suppression of this reflex.

Publication Type
Research Report


General Objective: To compare lidocaine, ketamine and propofol in suppressing fentanyl-induced cough on patients undergoing elective surgical procedures via general anesthesia.

Specific Objectives:

1) To evaluate the effectiveness ( in terms on the effects on the blood pressure, heart rate, oxygen saturation) after the administration of each drugs (Lidocaine, ketamine and propofol) and after injection of fentanyl.
2) To determine the occurrence and intensity of the cough within two minutes after the fentanyl injection.
3) To determine the occurrence of adverse events possible related to the administration of each drug (lidocaine, ketamine and propofol) after the injection of fentanyl.

LocationLocation CodeAvailable FormatAvailability
VSMMC Library Abstract Print Format
1. Barash, Paul , Cullen, Bruce F., Stoelting, Robert K.. Clinical anesthesia. Philadelphia: Lippincott Williams and Wilkins, 476-480. (6th ed.)
2. Pandey, Chandra Kant, Raza, Mehdi , Ranjan, Rajeev . Intravenous lidocaine suppresses fentanyl-induced coughing: a double-blind, prospective, randomized placebo controlled study.. Anesthesia-analgesia 2004.
3. Swartz, Jeffrey J., Rosenbaum, H. , Graf, George J.. Anasthesia and endocrine disease.. Clinical Anesthesia Lippincott Williams and Wilkins, 2001. (4rth ed.)
4. Kim, Ji Young, Jong-Yeop, Kim , Park, Sung Yong. "Effect of low dose ketamine to prevent remifentanil-induced cough: a randomized, double-blind, placebo controlled trial." Korean J Anesthesiol 56(6): 624-7, June 2009
5. Lin, CS , Sun, WZ , Chan, WH , Lin, CJ , Yeh, HM , Mok, MS . "Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough." CAN J ANESTH 51(7): 654-659, 2004
6. Miller, Ronald D., Eriksson, Lars I., Fleisher, Lee A., Weiner-Kronish, Jeanine P. , Young, William L. Associate editors. Miller's Anesthesia. Philadelphia: Churchill Livingstone, 2009. (7th ed. vo)
7. Phua, WT , Teh, BT , Jong, W. , Lee, TL , Tweed, WA . "Tussive effect of a fentanyl bolus. " Can J Anaesth 38, 330-4, 1991
8. Tweed, WA , Dakin, D. . "Explosive coughing after bolus fentanyl injection." Anaesth Analg 92, 1442-3, 2001

Copyright © One Window Project 2018. All rights reserved.