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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