EFFECT OF DIFFERENT PRIMING DOSES OF PROPOFOL ON THE INCIDENCE AND SEVERITY OF FENTANYL INDUCED COUGH IN PATIENTS WITH VARIOUS SMOKING STATUSES

Abstract

Background: Fentanyl-induced coughing (FIC) is not always benign and can be remarkably troublesome at the most critical moment of induction of anesthesia. Additionally, propofol has a significant sedative effect that may reduce the incidence of FIC.
Objectives: The aim of the study was to investigate the effect of different priming doses of propofol on the overall incidence and severity of FIC during induction of anesthesia. Also, to find the overall incidence and severity of FIC among patients with various smoking statuses.
Methods: This study was carried out on 100 ASA physical status I–II adult patients of both sexes who were scheduled for elective abdominal surgery under general anesthesia in Zagazig University Hospitals.
Patients were randomly classified according to propofol priming dose into 4 equal groups, (each one consisted of 25 patients ) , Group I received 0.15 mL/kg intralipid (placebo) iv, group II received 1 mg/kg propofol iv, group III received 1.5 mg/kg propofol iv, and group IV received 2 mg/kg propofol iv . One minute later, iv bolus injection of 2.5 mg/kg fentanyl was given to all patients of the 4 tested groups . During the two minutes following iv fentanyl injection , Patients who developed cough , beside cough severity , were detected and recorded . The hundred patients were classified again according to their smoking status into current smokers, former smokers and non smokers.
Results: Statistically, the demographic data (age, sex ratio, body weight, ASA ps class I/II ratio, the ratio of patient with/without past history of surgical intervention and the distribution of patients according to smoking status) of the 4 tested groups were comparable. The overall incidence of fentanyl induced cough in group III and group IV was significantly less than that of group I and group II . The incidence of each of mild, moderate and severe cough was significantly higher in group I and II than in group III and group IV. The overall fentanyl induced cough incidence was significantly higher in the current smokers than non smokers and former smoker patients .
Fentanyl induced cough incidence was 40% , 30%., 20% and 10% in non smoker patients of each of group I, II,III and IV respectively, 50% , 33.3%., 16.7 and 0% in the former smokers patients of each of group I, II,III and IV respectively and 40%, 30%., 15, and 15% in the current smokers patients of each of group I, II, III and IV respectively. Statistically, fentanyl induced cough incidence in non smoker patients of each of group III and group IV was significantly lower than that of each of group I & group II (P2 & P3< 0.05) Also, fentanyl induced cough incidence in the former smoker patients of group IV was significantly lower than that of each of group I & group II (P3 & P5< 0.05). Moreover, fentanyl induced cough incidence in the current smoker patients of each of group III and group IV was significantly lower than that of each of group I and group II (P2, P3, P4 and P5< 0.05) .
Conclusion: Priming dose of more than 1 mg/kg of propofol iv which was given 1 minute before fentanyl was effective in reducing the incidence and severity of fentanyl-induced cough in a dose-dependent manner in patients with various smoking statuses .
Key words: fentanyl, cough, propofol, smoking