Comparison of the Effects of Inhalational Salbutamol, Inhalational Beclomethasone and Intravenous Lidocaine in Prevention of Fentanyl-Induced Coughing before Induction of Anesthesia

Document Type : Research Paper




ntroduction: Fentanyl, a synthetic opioid is a popular choice amongst anesthesiologists in the operating room. Preinduction IV fentanyl bolus is associated with coughing in 28-45% of patients. Coughing due to fentanyl is not always benign and at times maybe explosive requiring immediate intervention. The goal of this study was to compare the role of inhalation of salbutamol beclomethasone and IV lidocaine in preventing fentanyl induced coughing.
Materials and Methods:This clinical trial study was performed in Ghaem Hospital in 2006. 320 patients aged 20-60 years, undergoing elective orthopedics surgery were randomized into four groups of 80. Group I served as control, while groups II, III, IV received an inhalation of salbutamol, beclomethasone or IV lidocaine before induction of anesthesia. Following IV fentanyl (2 μg/kg) the incidence of cough was recorded and graded as mild (1-2), moderate (3-4) and severe (≥5) depending on the number of coughs observed. Patients, characteristics and coughs, and the results of using different drugs were recorded in a questionnaire and analyzed by descriptive statistical methods. A p value of =< 0.05 was considered significant.
Results: The incidence of cough was 40% in the control group, 6.25%, 1.25% and 11.25% in the salbutamol, beclomethasone and lidocaine groups, respectively. Occurrence of cough was significantly low in the treatment groups; however the difference among the groups was not significant.
Conclusion: The use of inhalation salbutamol, beclomethasone or IV lidocaine prior to IV fentanyl administration minimizes fentanyl induced coughing, and in conditions like corneal rupture or increased intracranial pressure, which coughing is highly dangerous, they are beneficial.