Pharmacological and nonpharmacological prevention of fentanyl-induced cough: a meta-analysis

Fentanyl-induced cough (FIC) is often observed after intravenous bolus administration of fentanyl during anesthesia induction. This meta-analysis assessed the efficacy of pharmacological and nonpharmacological interventions to reduce the incidence of FIC. We searched for randomized controlled trials comparing pharmacological or nonpharmacological interventions with controls to prevent FIC; we included 28 studies retrieved from PubMed, Embase, and Cochrane Library. Overall incidence of FIC was approximately 31 %. Lidocaine [odds ratio (OR) = 0.29, 95 % confidence interval (CI) 0.21-0.39], N-methyl-D-aspartate (NMDA) receptor antagonists (OR 0.09, 95 % CI 0.02-0.42), propofol (OR 0.07, 95 % CI 0.01-0.36), alpha(2) agonists (OR 0.32, 95 % CI 0.21-0.48), beta(2) agonists (OR 0.10, 95 % CI 0.03-0.30), fentanyl priming (OR 0.33, 95 % CI 0.19-0.56), and slow injection of fentanyl (OR 0.25, 95 % CI 0.11-0.58)] were effective in decreasing the incidence of FIC, whereas atropine (OR 1.10, 95 % CI 0.58-2.11) and benzodiazepines (OR 2.04, 95 % CI 1.33-3.13) were not effective. This meta-analysis found that lidocaine, NMDA receptor antagonists, propofol, alpha(2) agonists, beta(2) agonists, and priming dose of fentanyl were effective in preventing FIC, but atropine and benzodiazepines were not. Slow injection of fentanyl was effective in preventing FIC, but results depend on the speed of administration.