An infusion of fentanyl may be given as part of balanced anesthesia. Some patients who receive fentanyl develop a cough, which can be severe.
Mechanism of cough: possibly histamine release
Situations where the cough may be detrimental:
(1) open globe injury
(2) increased intracranial pressure
Fentanyl-induced cough is a risk factor for postoperative nausea and vomiting (PONV), especially in patients with other risk factors for PONV (younger age, female, nonsmoker, other).
Prevention of fentanyl-induced cough may include:
(1) slow infusion of the fentanyl (avoiding rapid dosing)
(2) administering a small fentanyl dose 1-3 minutes prior to the main infusion
(3) pretreatment with propofol
(4) lidocaine
(5) butorphanol
(6) beta-2 agonist
(7) N-methyl-D-aspartate receptor antagonists
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