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PubMed2001

Placental transfer of temazepam and fentanyl in early human pregnancy.

The placental transfer of temazepam and fentanyl was studied in 37 women undergoing surgical termination of pregnancy between 12 and 17 weeks. The women received temazepam 10 mg, approximately 1 h pre-operatively and fentanyl 2 &mgr;g/kg intravenously, at induction of anaesthesia. A single 2 ml fetal blood sample was taken from each anaesthetized subject using an ultrasound-guided trans-abdominal puncture at either 5, 10, 15 or 20 min after administration of fentanyl. A maternal blood sample was collected simultaneously and both were assayed for temazepam and fentanyl. Both drugs were detected in all fetal serum samples. Fetal:maternal (F:M) drug concentration ratio was 0.38 for temazepam, which did not change between 60 and 120 min after oral administration to the mother. Overall F:M ratio for fentanyl was 1.87 for fentanyl, which increased from 1.42 at 5 min to 2.6 at 20 min. F:M ratio of fentanyl concentrations increased with time (r = 0.48, P < 0.003), whereas F:M ratio of temazepam concentrations did not change significantly with time, between 50 and 120 min after the drug was administered to the mother (r = 0.32, P = 0.06). F:M ratios changed with gestational age of the fetus for both drugs, increasing as gestational age increased in the case of temazepam (r = 0.47, P = 0.003) and decreasing in the case of fentanyl (r = 0.38, P = 0.02). These changes can be explained by variation in uterine blood flow, trophoblast membrane thickness and feto-placental metabolism. These results also indicate that the in-vitro study of these drugs is unlikely to reflect the in-vivo situation in early pregnancy.

Journal Article↗
PubMed2005

Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section.

BACKGROUND: Potentiating the effect of intrathecal local anesthetics by addition of intrathecal opiods for intra-abdominal surgeries is known. In this study by addition of fentanyl we tried to minimize the dose of bupivacaine, thereby reducing the side effects caused by higher doses of intrathecal bupivacaine in cesarean section. METHODS: Study was performed on 120 cesarean section parturients divided into six groups, identified as B8, B10 and B 12.5 8.10 and 12.5 mg of bupivacaine mg and FB8, FB10 and FB 12.5 received a combination of 12.5 mug intrathecal fentanyl respectively. The parameters taken into consideration were visceral pain, hemodynamic stability, intraoperative sedation, intraoperative and postoperative shivering, and postoperative pain. RESULTS: Onset of sensory block to T6 occurred faster with increasing bupivacaine doses in bupivacaine only groups and bupivacaine -fentanyl combination groups. Alone lower concentrations of bupivacaine could not complete removed the visceral pain. Blood pressure declined with the increasing concentration of Bupivacaine and Fentanyl. Incidence of nausea and shivering reduces significantly whereas, the postoperative pain relief and hemodynamics increased by adding fentanyl. Pruritis, maternal respiratory depression and changes in Apgar score of babies do not occur with fentanyl. CONCLUSION: Spinal anesthesia among the neuraxial blocks in obstetric patients needs strict dose calculations because minimal dose changes, complications and side effects arise, providing impetus for this study. Here the synergistic, potentiating effect of fentanyl (an opiod) on bupivacaine (a local anesthetic) in spinal anesthesia for cesarian section is presented, fentanyl is able to reduce the dose of bupivacaine and therefore its harmful effects.

Journal Article↗
PubMed1998

Fentanyl decreases beta-CIT binding to the dopamine transporter.

Evidence from animal studies suggest that centrally acting opiates increase synaptic dopamine (DA) concentration. However, the interaction between mu-opioid receptors and the DA system is unclear. We report here an effect of fentanyl on striatal [123I]beta-CIT binding to the DA transporter in a patient and in rats. A female patient underwent [123I]beta-CIT single-photon emission tomography (SPET) study after intrathecal injection of fentanyl for her back pain. After a 2-week drug-free period, the SPET study was repeated. In the experimental study, male Wistar rats were treated with fentanyl either acutely (50 micrograms/kg, i.p.) before imaging study or subacutely for 4 days (10 micrograms/kg, twice a day, i.p.). Brain planar imaging was performed at 3.5 hours after an intravenous injection of [123I]beta-CIT with gamma camera with a pinhole collimator. In a female patient, [123I]beta-CIT binding in the basal ganglia was decreased by 37% during fentanyl as compared to the binding after 2-week drug-free period. Similarly in rats, acute fentanyl treatment decreased [123I]beta-CIT binding to the striatum by 30% as compared to that of with the control rats. After subacute administration of fentanyl, no significant difference was observed compared to the control group. According to the present data, fentanyl decreases [123I]beta-CIT binding in the basal ganglia both in human and rats, suggesting that opiates possibly directly affect DA reuptake.

Adult↗
PubMedDate not supplied

Influence of intravenous fentanyl on fetal biophysical parameters during labor.

The short-acting opioid fentanyl has been shown to be a useful analgesic during labor. The purpose of this prospective, comparative investigation was to determine whether fentanyl influenced fetal biophysical parameters during labor. Twenty-four uncomplicated pregnancies at 37-41 weeks were studied during the early active phase of labor. Those patients who requested analgesia (study group) were given a standard 50-micrograms dose of fentanyl intravenously. The study (N = 12) and control (N = 12) groups were similar in maternal age, parity, and gestational age distribution. Fetal body and breathing movements and heart rate patterns were evaluated continuously for 80 min at 10-min epochs. Unlike the control group, fetuses exposed to fentanyl had fewer body movements between contractions (P < 0.03) and spent less overall time moving (P < 0.02). Breathing was abolished at 10 min postdosing in all fetuses exposed to fentanyl but not in the control group. The FHR beat-to-beat variability was reduced between contractions for the first 30 min in 8 (66%) of study cases and none of the control cases (P < 0.01). A sine wave-like FHR pattern was observed for 30 min in two fetuses exposed to fentanyl. All infants had 1- and 5-minute Apgar scores > 6, an umbilical artery pH > 7.20, and no need for resuscitation. In conclusion, an intravenous dose of fentanyl during early active labor was associated with temporary depressant effects on many fetal biophysical parameters without apparent harm being observed at delivery.

Analgesics, Opioid↗
PubMed2001

Intravenous methadone in the management of chronic cancer pain: safe and effective starting doses when substituting methadone for fentanyl.

BACKGROUND: Patients often are rotated from other opioids to methadone when side effects occur before satisfactory analgesia is achieved. Various strategies have been proposed to estimate safe and effective starting doses of methadone when rotating from morphine and hydromorphone; however, there are no guidelines for estimating safe and effective starting doses of methadone when rotating from fentanyl. METHODS: The authors prospectively observed 18 consecutive patients experiencing chronic pain from cancer who underwent opioid rotation from intravenous patient-controlled analgesia (PCA) with fentanyl to intravenous PCA with methadone. Patients were switched from fentanyl to methadone because of uncontrolled pain associated with sedation or confusion. A conversion ratio of 25 microg/hour of fentanyl to 0.1 mg/hour of methadone was used to calculate the initial dose of methadone in all patients. RESULTS: Mean pain scores decreased from 8.1 to 4.8 on Day 1 after the switch and to 3.22 on Day 4 after the switch. Mean sedation scores were 1.5 before the switch and 0.44 and 0.16 on Days 1 and 4, respectively. Among the 6 patients who experienced confusion while on fentanyl before the switch, 5 improved within 2 days of the switch. None of the patients experienced toxicity from methadone. CONCLUSIONS: On the basis of this preliminary study, the authors suggest that when switching from intravenous fentanyl to methadone a conversion ratio of 25 microg/hour of fentanyl to 0.1 mg/hour of methadone may be safe and effective.

Adult↗
PubMed1995

Evaluation of diurnal variation in fentanyl clearance.

Drug disposition kinetics are commonly assumed to be time-invariant as a first approximation. In a preliminary study, 6 healthy volunteers received a constant intravenous infusion of 50 micrograms/h for 48 hours; the serum fentanyl concentration at 36 hours was lower than that at 24 hours for all 6 subjects. This suggested possible diurnal variations in fentanyl clearance. In 2 subsequent studies, with healthy volunteers receiving short infusions of fentanyl (n = 9, 150 micrograms/h for 0.33 hours every 4 hours; n = 12, 150 micrograms/h for 0.33 hours every hour, respectively), the area under the serum fentanyl concentration curve appeared to be independent of the time of infusion. Thus, there was no evidence to support a large diurnal change in fentanyl clearance. The serum fentanyl concentration-time profiles, corrected for carryover from previous doses, within each study were superimposable. This suggests that there are no diurnal changes in the distribution kinetics of fentanyl.

Circadian Rhythm↗
PubMed2005

Utilisation pattern of fentanyl transdermal system in The Netherlands.

PURPOSE: To describe the utilisation pattern of TTS fentanyl in daily practice. METHODS: A retrospective cohort study was performed with data from the Dutch PHARMO system, including medication and hospital admission records of 850,000 inhabitants of 25 Dutch cities. New starters of TTS fentanyl with at least two consecutive prescriptions in the period of 1 January 1996 through 31 December 2001 were included in the study cohort. Patients were distinguished in having non-cancer or cancer pain. RESULTS: About 61% of the patients suffered from non-cancer pain and 60% used other opioids before start of TTS fentanyl. The majority of the patients used other pain medication during the first treatment episode. Most patients (74%) started treatment with the lowest dose of TTS fentanyl (25 microg/hour), patients with cancer pain more often started with higher doses. About half of the patients changed type of patch during the first treatment episode, 80% of these patients had an increase in dose of TTS fentanyl. Fifty percent of all patients had a first treatment episode of less than 2 months and more than one third did not renew their prescription within two months. The median number of days of use per patch was 2.2 days for all patients. CONCLUSIONS: The use of TTS fentanyl is limited to a short period of time for a substantial percentage of patients starting treatment. The median duration of use per TTS fentanyl patch i.e. 2.2 days, was lower than the 3 days application period recommended in the summary of product characteristics.

Administration, Cutaneous↗
PubMed1994

Fentanyl stimulates atrial natriuretic peptide secretion.

The effects of fentanyl on ultrastructure, protein biosynthesis, and atrial natriuretic peptide (ANP) secretion were studied in neonatal rat cardiomyocytes (CM). Ventricles from 2-day-old American Wistar rats were digested with 1% collagenase in perfusion buffer. Eight hundred thousand to 1.0 million cells/ml were incubated in tissue culture media, to which fentanyl citrate (Sublimaze) was added in a dose of 10-50 ng/ml. Fentanyl increased the spontaneous CM beating rate, which became rather fibrillary in nature. Protein biosynthesis also increased in a time-related manner. Simultaneous incubation with naloxone (10(-6) M) did not alter the beating rate or protein synthesis. Ultrastructurally, several criteria of myocyte growth were observed: an increase in myofilaments and the appearance of newly formed organized sarcomeres, which were preceded by an increase in the ribosomes and cisternae of rough endoplasmic reticulum, and the appearance of large, adult-type mitochondria with increased matrix granules and long parallel cristae. The latter replaced the elongated thin fetal mitochondria. This was associated with a network of developing sarcoplasmic reticulum and T-tubular system as well as the formation of intercalated discs between the CM. Furthermore, exposure to fentanyl increased ANP immunoreactivity in the culture media while simultaneous incubation with naloxone blocked the effect of fentanyl on ANP secretion. On the other hand, naloxone alone did not alter ANP secretion. Therefore, it could be concluded that fentanyl stimulated protein biosynthesis and ANP secretion as evidenced both biochemically and ultrastructurally. Although the molecular mechanism of ANP secretion by fentanyl is still unclear, yet an opioid receptor mediation could be possible as ANP secretion was blocked by an opioid receptor antagonist (naloxone).

Animals↗
PubMed1984

Sequestration of fentanyl by the cardiopulmonary bypass (CPBP).

Immediately following the connection of pediatric patients to cardiopulmonary bypass we have consistently observed a steep decrease in fentanyl plasma concentration (74 +/- 8.7%) (mean +/- SD), much greater than would have been expected from hemodilution alone (50.6% +/- 12.0%) (p less than 0.0001). Priming of the pump with 20 ng/ml of fentanyl before connection to the patients did not prevent this phenomenon. In order to study the possibility that fentanyl is sequestered by the bypass, levels of the primed drug in the bypass were assessed before connecting the pump to the children and a steep fall from 20 ng/ml to zero was shown before initiation of bypass. Pharmacokinetic assessment of fentanyl in a closed pump circuit showed that levels of 120 ng/ml fall to 2 ng/ml within 3 min and remain stable at the lower concentration for at least 30 min. Further studies have identified the membrane oxygenator as the major site of fentanyl sequestration. Concentrations across the membrane fall from 120 ng/ml to 10 ng/ml. The attached siliconized tubing is associated with a minor binding effect sufficient to reduce concentrations from 110 to 84 ng/ml. The pvc tubing, aluminium heat exchanger and plastic reservoir had no binding effect on fentanyl. The possibility that a decrease in fentanyl protein binding caused the fall in serum concentration was checked in 5 patients undergoing open heart surgery. After initiation of the cardiopulmonary bypass, there was a significant decrease in albumin serum concentrations from 32.0 +/- 2.3 mM to 15.0 +/- 1.6 mM (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Transdermal fentanyl improves management of postoperative hemorrhoidectomy pain.

PURPOSE: Outpatient postoperative hemorrhoidectomy pain remains a difficult problem. The purpose of this study is to evaluate the use of transdermal fentanyl for analgesia following hemorrhoidectomy. METHODS: Patients were prospectively randomized in a double-blind fashion to one of two groups, placebo or transdermal fentanyl. Forty-two patients were eligible for the study (placebo, 21; fentanyl, 17; 4 were excluded). A visual analog scale was used to evaluate postoperative pain (0 = no pain; 10 = worst pain). RESULTS: Fewer patients in the fentanyl group (10/17) required postoperative parental narcotics than the placebo group (21/21) (P < 0.05 Fisher's exact test). The amount of narcotics consumed postoperatively was significantly less in the fentanyl group (97.05 mg of meperidine +/- 23.27) than in the placebo group (236.19 +/- 30.46) (P < .05 Student's t-test). Pain scores in the fentanyl group were significantly lower (less pain) than in the placebo group (P < 0.05 Kruskal-Wallis). CONCLUSION: Results indicate that use of transdermal fentanyl provides an effective analgesic alternative that improves the transition to noninvasive outpatient pain management in the hemorrhoidectomy patient.

Administration, Cutaneous↗
PubMed1988

Fentanyl-induced conditional place preference: lack of associated conditional neurochemical events.

Three experiments were performed to determine if stimuli previously paired with the reinforcing effects of fentanyl elicit changes in the activity of dopaminergic neurons that are similar to the unconditional effects of the drug. Experiment 1 characterized the unconditional effects of fentanyl (0.04 mg/kg SC) on neurochemical indices of dopaminergic activity in rats. Both acute and repeated fentanyl injections (five injections administered at 48-h intervals) increased the concentrations of the dopamine metabolites 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) within the striatum (STR), nucleus accumbens (NAS), and olfactory tubercle (OT). Acute injections elicited a greater increase in metabolite concentrations in the NAS than in the STR, suggesting that there are regional differences in the sensitivity of dopaminergic neurons to fentanyl. In experiments 2 and 3, fentanyl (five injections; 0.04 mg/kg SC) was paired with environmental stimuli using a place preference conditioning paradigm. The fentanyl-paired stimuli failed to elicit conditional changes in DOPAC or HVA concentrations within the STR, NAS, or OT even though rats exhibited a preference for the drug-paired compartment of the shuttle box. These results indicate that the secondary reinforcing effects of stimuli previously paired with fentanyl may not reflect the ability of these stimuli to elicit measurable changes in the activity of mesolimbic or nigrostriatal dopaminergic neurons.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1992

A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction.

The purpose of this randomized, double-blind study was to compare the ability of a combination of fentanyl and esmolol to blunt the haemodynamic effects of intubation with that of either agent alone. Patients received fentanyl or saline four minutes before, and esmolol or saline two minutes before rapid-sequence induction of anaesthesia. The F2 group (n = 24) received fentanyl 2 micrograms.kg-1, the E2 group (n = 24) received esmolol 2 mg.kg-1, the F2/E2 group (n = 25) received a combination of fentanyl 2 micrograms.kg-1 and esmolol 2 mg.kg-1, and the F5 group (n = 26) received fentanyl 5 micrograms.kg-1. Following tracheal intubation, the maximum percent change from baseline heart rate was less in the F2/E2 and F5 groups (12% and 16% respectively) than in the E2 group (34%)(P < 0.05). The maximum percent changes from baseline systolic blood pressure in the F2/E2 and F5 groups (15% and 6% respectively) were less than in the F2 and E2 groups (24% and 33% respectively) (P < 0.05). The combination of a low dose of fentanyl and esmolol provides an alternative to a higher dose of fentanyl for blunting the haemodynamic responses to laryngoscopy and tracheal intubation during rapid-sequence induction in healthy patients.

Adrenergic beta-Antagonists↗
PubMed1995

Patient-controlled analgesia following caesarean section under general anaesthesia: a comparison of fentanyl with morphine.

This prospective, randomised, double-blind study compared PCA fentanyl with PCA morphine for post-Caesarean section analgesia. Following a standardised general anaesthetic, 37 women were allocated to receive either fentanyl (n = 18) or morphine (n = 19). The PCA was commenced after the women had been made comfortable in the postanaesthetic recovery room with the appropriate opioid solution (mean dose required = fentanyl 375 micrograms or morphine 16 mg). Initial PCA settings were bolus 1 ml (fentanyl 25 micrograms or morphine 1 mg), lockout time ten minutes, and no background infusion. Both analgesic solutions provided effective analgesia for a mean of 37 hr with high levels of patient satisfaction, and there were no differences in VAS scores for pain and patient satisfaction, or for side effects (nausea, itch, and sleepiness) between fentanyl or morphine. However, more patients in the fentanyl group required supplementary boluses or alterations to the PCA settings (13/18 vs 4/19: P = 0.005), and one patient was removed from the study due to inadequate analgesia. We conclude that fentanyl is not recommended for routine PCA use following Caesarean section.

Adult↗
PubMed1985

Low-dose fentanyl: haemodynamic response during induction and intubation in geriatric patients.

Twenty-eight surgical patients aged 65-84 were randomly assigned to either a control group (12) induced with thiopentone alone, or a treatment group (16), induced with 3 micrograms . kg-1 fentanyl followed by thiopentone, to determine whether the use of fentanyl during induction would attenuate the cardiovascular response to laryngoscopy and intubation. Patients in the fentanyl group required 47 per cent less thiopentone for induction. Increases in systolic (SBP) and diastolic (DBP) blood pressure were significantly smaller in the group receiving fentanyl at one minute post intubation. SBP rose by 56 mmHg in the control group, compared to 15 mmHg in the fentanyl group; DBP increased 42 mmHg compared to 20 mmHg, respectively. Increases in rate-pressure product were twice as great in the control group compared to the fentanyl group (72.2 vs 36.0 per cent, respectively). Thus, fentanyl, as an adjunct to barbiturate induction, effectively lowered the thiopentone requirement and attenuated the pressor response to laryngoscopy and intubation.

Aged↗
PubMed1996

Terbutaline inhalation suppresses fentanyl-induced coughing.

PURPOSE: To study the suppressive effect of inhalation of a selective beta 2-adrenergic bronchodilator terbutaline, and the effect of an intravenous anticholinergic, atropine, on fentanyl-induced coughing. METHODS: We studied 131 ASA class I patients, aged 16-45 yr, scheduled for elective surgery, randomized into four groups. Fifteen minutes before bolus fentanyl (5 micrograms.kg-1, iv), patients inhaled either normal saline (4 ml; Group I, n = 30) or terbutaline (5 mg in 2 ml normal saline; Group 2, n = 34) via a jet nebulizer. After inhalation of normal saline, patients in Group 3 (n = 32) received sterile water iv instead of fentanyl. Patients in Group 4 (n = 35) were pretreated with atropine (0.01 mg.kg-1, iv) 10 min before iv fentanyl bolus. The onset, frequency and intensity of cough were observed immediately by an anaesthetist blinded to the study. RESULTS: The cough frequency was higher in Groups I (43%) and 4 (46%) than in Groups 2 (3%) and 3 (0%) (P < 0.05). The onset time and intensity of cough showed no difference among groups. No truncal rigidity was observed in patients receiving fentanyl bolus iv. The blood pressure, heart rate, and peripheral oxygen saturation did not change in Groups 1, 2, and 3, while patients in Group 4 showed an increase in heart rate (25.5 +/- 15.2%). CONCLUSIONS: The inhalation of a selective beta 2-adrenergic bronchodilator, terbutaline, effectively inhibited fentanyl-induced cough, whereas atropine, an antimuscarinic vagolytic, had no efficacy. Our results suggest that bronchoconstriction may underlie the mechanism on fentanyl-induced cough.

Administration, Inhalation↗
PubMed2001

Intrathecal pre-administration of fentanyl effectively suppresses formalin evoked c-Fos expression in spinal cord of rat.

PURPOSE: To investigate whether the timing of intrathecal administration of the opioid analgesic fentanyl, alters noxious stimulus-evoked neuronal activity in the rat spinal cord. METHODS: A 5% formalin solution was used as the noxious stimulant. For the pretreatment group, a dose of 0.001 to 0.5 microg of fentanyl was injected intrathecally ten minutes prior to formalin injection. Early and late post-treatment groups received 0.01 to 0.5 microg fentanyl, five and 60 min after formalin injection respectively. The effect of fentanyl was confirmed with naloxone. The level of c-Fos expression was determined in each treatment group to indicate neuronal activity. RESULTS: Pretreatment and early post-treatment groups showed suppression of c-Fos activity compared to the vehicle (P <0.01). The late post-treatment group showed no difference in c-Fos activity compared to the vehicle (P=NS). Pretreatment with fentanyl showed the most profound suppression of c-Fos expression (P <0.01). In addition, pretreatment injection showed a greater suppression of c-Fos activity in the deep (14.6% of control) compared to the superficial laminae (32.7% of control; P <0.01), whereas the early post-treatment group showed a universal decrease in c-Fos activity (49.2% of control in laminae I and II, 50.4% of control in laminae III and IV and 51.8% of control in laminae V and VI). Naloxone reversed the action of fentanyl on c-Fos activity. CONCLUSION: Inasmuch as: 1) c-Fos expression can be equated with behavioural changes; 2) injection of formalin is an appropriate model of surgical trauma; and 3) animal data can be transports to humans, these results suggest that fentanyl would be an effective pre-emptive analgesic.

Analgesia↗
PubMed2001

The addition of fentanyl does not alter the extent of spread of intrathecal isobaric bupivacaine in clinical practice.

PURPOSE: Fentanyl is commonly added to intrathecal local anesthetic solutions. In vitro data has shown fentanyl to render isobaric local anesthetics hypobaric, and alter the spread in artificial cerebrospinal fluid. This study examined whether the addition of fentanyl to isobaric bupivacaine with morphine leads to a clinically important alteration in the extent of spread of anesthesia. METHODS: Forty-four ASA I-III patients undergoing lower limb orthopedic procedures completed this double-blind, placebo-controlled trial. Patients were randomized into one of two groups, receiving intrathecal bupivacaine 15 mg and preservative-free morphine 200 microg without (Control group), or with the addition of fentanyl 0.02 mg (Fentanyl group). Patients were maintained at a slight head-up tilt. Variables studied over three hours included sensory level to cold and pinprick, motor blockade (Bromage scale), and circulatory data. RESULTS: No differences existed between the Fentanyl and Control groups with respect to highest level of block for cold: T4 (T2-T5) vs T3.5 (T3-T8) respectively (median, 95% confidence interval) or pinprick: T4 (T3-T6) vs T4.5 (T3-T8). Similarly, there was no difference in the time taken to reach maximum block height to cold (20 +/- 9 vs 23 +/- 13 min, mean +/- SD) or pinprick (20 +/- 9 vs 24 +/- 13 min). CONCLUSION: The addition of fentanyl 0.02 mg to 0.5% bupivacaine with morphine does not affect the maximal block height or time to maximal block in clinical practice.

Adult↗
PubMed2003

Salbutamol, beclomethasone or sodium chromoglycate suppress coughing induced by iv fentanyl.

PURPOSE: 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 may be explosive requiring immediate intervention. We have studied the role of aerosol inhalation of salbutamol, beclomethasone and sodium chromoglycate in preventing fentanyl induced coughing and have compared their efficacy. METHODS: Two hundred patients aged 18-60 yr, undergoing elective laparoscopic cholecystectomy were randomized into four groups of 50 each. Group I served as control, while Groups II, III and IV received an aerosol inhalation of salbutamol, beclomethasone or sodium chromoglycate 15 min prior to entering the operating room. Following iv fentanyl (2 micro g x kg(-1)) the incidence of cough was recorded and graded as mild (1-2), moderate (3-5) and severe (> 5) depending on the number of coughs observed. Results were analyzed using 'z' and Fischer's Exact test. A P value of < or = 0.05 was considered significant. RESULTS: The incidence of cough was 28% in the control group, 6%, 0% and 4% in the salbutamol, beclomethasone and sodium chromoglycate groups respectively. Occurrence of cough was significantly low (P < or = 0.05) in the treatment groups, however the difference amongst the groups was not significant (P >/= 0.05). CONCLUSION: The use of salbutamol, beclomethasone or sodium chromoglycate aerosol 15 min prior to iv fentanyl administration minimizes fentanyl-induced coughing.

Adolescent↗