The current study defines the suppressive effect of inhalation of a selective beta 2-adrenergic bronchodilator terbutaline, and the impact of an intravenous anticholinergic, atropine, on fentanyl-induced coughing.

The authors included 131, ASA class I patients, aged 16-45 yr, scheduled for elective surgery. They were further categorize into four groups and 15 minutes before bolus fentanyl (5 micrograms.kg-1, iv), patients inhaled either normal saline (4 ml; Group I) or terbutaline (5 mg in 2 ml normal saline; Group 2) through a jet nebulizer. Patients in Group 3 administered with sterile water iv as a substitute of fentanyl, after inhalation of normal saline. Patients in Group 4 were pretreated with atropine (0.01 mg.kg-1, iv) 10 min before iv fentanyl bolus. A blind evaluation was done by an anaesthetist about the onset, frequency and intensity of cough.

The results revealed that cough frequency was higher in Groups I (43%) and 4 (46%) in contrast to in Groups 2 (3%) and 3 (0%). No difference in the onset time and intensity of cough was seen among different groups. No truncal rigidity was reported in patients receiving fentanyl bolus iv. No variation was seen in the blood pressure, heart rate, and peripheral oxygen saturation in Groups 1, 2, and 3, while Group 4 reported an increase in heart rate (25.5 +/- 15.2%).

Thus, it can be established that the inhalation of a selective beta 2-adrenergic bronchodilator such as terbutaline can successfully impede fentanyl-induced cough, which is attributed to the bronchoconstriction implicated in the mechanism of fentanyl-induced cough.

Source: Lui PW, Hsing CH, Chu YC. Can J Anaesth. 1996 Dec;43(12):1216-9.