Abstract
Objective: To evaluate the efficacy of intravenous Lidocaine in preventing Fentanyl-induced cough in pediatric patients undergoing general anesthesia.
Methods: Study design: a randomized, double-blind clinical trial conducted at Saint Paul General Hospital. Participants: one hundred pediatric patients aged 4-10 years, ASA physical status I-II, undergoing elective surgery under general anesthesia, were randomly allocated in a 1:1 ratio. Intervention: the Lidocaine group received intravenous Lidocaine 1 mg/kg, while the control group received a placebo (0.9% normal saline). Both were administered one minute prior to induction with intravenous Fentanyl at 2 µg/kg. Outcome measures: the incidence of cough and the number of cough episodes following Fentanyl injection were recorded. Cough severity was classified as mild (1-2 episodes), moderate (3-4 episodes), or severe (≥ 5 episodes).
Results: The incidence of Fentanyl-induced cough was significantly lower in the Lidocaine group compared with the control group (14% vs. 50%, p < 0.05). No cases of severe cough were observed in the Lidocaine group, whereas 8% of patients in the control group experienced severe coughing episodes. Overall, cough severity was milder in the Lidocaine group, with most cases classified as mild, compared with the control group.
Conclusion: Intravenous administration of Lidocaine at a dose of 1 mg/kg prior to Fentanyl injection markedly reduces both the incidence and severity of Fentanyl-induced cough in children. This is a safe, easily applicable preventive measure that may offer meaningful benefits in pediatric anesthesia practice
Keywords
Lidocaine, cough, Fentanyl, children, general anesthesia.
References
[1]
Tyson A.F, Msiska N, Kiser M, Samuel J.C, McLean S, Varela C, Charles A.G. Delivery of operative pediatric surgical care by physicians and non-physician clinicians in Malawi. Int J Surg, 2014, 12 (5): 509-515. doi: 10.1016/j.ijsu.2014.02.009.
Google Scholar
[2]
Ambesh S, Singh N, Srivastava K. Fentanyl induced coughing caused life-threatening airway obstruction in a patient with arteriovenous malformation of tongue and hypopharynx. The Internet Journal of Anesthesiology, 2009, 20 (1): 7. https://doi.org/10.5580/2.
Google Scholar
[3]
Gecaj-Gashi A, Nikolova-Todorova Z, Ismaili-Jaha V, Gashi M. Intravenous Lidocaine suppresses Fentanyl-induced cough in Children. Cough, 2013, 9: 20. doi: 10.1186/1745-9974-9-20.
Google Scholar
[4]
Tan W, Li S, Liu X, Gao X, Huang W, Guo J, Wang Z. Prophylactic Intravenous Lidocaine at Different Doses for Fentanyl-Induced Cough (FIC): A Meta-Analysis. Sci Rep, 2018, 8 (1): 9946. doi: 10.1038/s41598-018-27457-3.
Google Scholar
[5]
Chen R, Tang L.H, Sun T, Zeng Z, Zhang Y.Y, Ding K, Meng Q.T. Mechanism and Management of Fentanyl-Induced Cough. Front Pharmacol, 2020, 11: 584177. doi: 10.3389/fphar.2020.584177.
Google Scholar
[6]
Kim J.E, Min S.K, Chae Y.J, Lee Y.J, Moon B.K, Kim J.Y. Pharmacological and nonpharmacological prevention of Fentanyl-induced cough: a meta-analysis. J Anesth, 2014, 28 (2): 257-66. doi: 10.1007/s00540-013-1695-4.
Google Scholar
[7]
Pandey C.K, Raza M, Ranjan R, et al. Intravenous Lidocaine 0.5 mg.kg-1 effectively suppresses Fentanyl-induced cough. Can J Anaesth, 2005, 52 (2): 172-5. doi: 10.1007/bf03027724.
Google Scholar
[8]
Phuvachoterojanaphokin N, Watanaboonyongcharoen G, Jinawong S, Munjupong S. Low-dose Lidocaine attenuates Fentanyl-induced cough: A double-blind randomized controlled trial. Eur J Clin Pharmacol, 2022, 78 (5): 813-821. doi: 10.1007/s00228-022-03282-6.
Google Scholar
[9]
Golmohammadi M, Shajiee S, Sane S, Valie M. Comparison of the effects of pretreatment intravenous Fentanyl or intravenous Lidocaine on suppression of Fentanyl-induced cough in children: a randomized, double-blind, controlled clinical trial. Electron Physician, 2018, 10 (6): 6877-6883. doi: 10.19082/6877.
Google Scholar
[10]
Kim J.E, Min S.K, Chae Y.J, Lee Y.J, Moon B.K, Kim J.Y. Pharmacological and nonpharmacological prevention of Fentanyl-induced cough: a meta-analysis. Journal of Anesthesia, 2014, 28 (2): 257-266. doi: 10.1007/s00540-013-1695-4.
Google Scholar