Cough fentanyl

Morphine has certain undesirable side effects. Among these are respiratory depression, nausea, and vomiting, depression of the cough reflex, cardiovascular depression and hypotension, smooth muscle contraction (constipation), and histamine release (93). Morphine s onset of action, duration, and low therapeutic indices have prompted a search for a more effective opiate iv anesthetic. Extreme simplification of the complex morphine molecule has resulted in anilido —piperidines, the fentanyl class of extremely potent opiate iv anesthetics (118,119). 

Alkaloids range from the belladonna alkaloids, such as atropine and scopalomine—which are used as poisons, cold remedies, and truth serums —to dextromethorphan, a cough suppressant (anti-tussive). But the most widely known alkaloids are the opiates, such as morphine, heroin, fentanyl, oxycodone, and methadone. These act on... 

Among the compounds that fall within this class are hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin—an oral, controlled-release form of the drug), morphine, fentanyl, codeine, and related medications. Morphine and fentanyl are often used to alleviate severe pain, while codeine is used for milder pain. Other examples of opioids prescribed to relieve pain include propoxyphene (Darvon) hydromorphone (Dilaudid) and meperidine (Demerol), which is used less often because of its side effects. In addition to their effective pain-relieving properties, some of these medications can be used to relieve severe diarrhea (for example, Lomotil, also known as diphenoxylate) or severe coughs (codeine). 

Table 8.3 shows a selective timeline of the evaluation, abuse, and regulation of DXM, a nonnarcotic cough suppressant with activity at sigma and PCP receptors. Unlike butorphanol and fentanyl, it has never been scheduled in the Controlled Substances Act, and it is available without a prescription in various over-the-counter formulations. 

Sucrets 4-Hour Cough Suppressant see Dextromethorphan Sufenta see Fentanyl... 

Fentanyl can evoke the pulmonary chemoreflex, as evidenced by 50% of patients in one study and 28% in another, who coughed after the administration of fentanyl through a central line (SEDA-16, 79) (8). The coughing caused by fentanyl is inhibited by terbutaline (SEDA-21, 88). 

A 7-year-old boy with trisomy 21 (Down syndrome) had explosive coughing, 30 seconds after fentanyl 50 pg (2 pg/kg) had been injected and flushed through an intravenous cannula. The cough was unproductive and persisted in spasmodic bursts for a further 2-3 minutes until anesthesia was induced with propofol 60 mg and atracurium 15 mg intravenously. The coughing immediately ceased. A petechial rash in the conjuncti-vae and periorbital regions was subsequently noted and disappeared by the end of the first postoperative day. 

Tweed WA, Dakin D. Explosive coughing after bolus fentanyl injection. Anesth Analg 2001 92(6) 1442-3. 

Nalbuphine has similar efficacy and incidence of adverse effects to tramadol and paracetamol (acetaminophen) (3). Dysrhythmias and coughing occurred more often with nalbuphine than fentanyl (4). 

Skin A 37-year-old woman developed generalized dermatitis, with pruritus, rash, and edema, after taking a codeine-containing cough mixture for a common cold [65 ]. A codeine-challenge test resulted in the same clinical picture. She had good tolerance to fentanyl and tramadol but not to other opioids. 

Respiratory The effects of dexmedetomi-dine and fentanyl on airway reflexes and hemodynamic responses to tracheal extuba-tion have been compared in a double-blind, randomized, controlled trial in 40 patients undergoing rhinoplasty [82 ]. Dexmedeto-midine was better than fentanyl in attenuating airway reflex responses to tracheal extubation (increased prevalence of cough after extubation with fentanyl) and in maintaining hemodynamic stability without prolonging the recovery phase. 

In 300 patients randomly allocated to receive lidocaine, ketamine, or placebo, fentanyl-induced cough responded to intravenous lidocaine 1 mg/kg or ketamine 0.5 mg/kg [84 ]. The frequency and... 

Guler G, Aksu R, Bicer C, Tosun Z, Boyaci A. Comparison of the effects of ketamine or lidocaine on fentanyl-induced cough in patients undergoing surgery a... 

Schapermeier U, Hopf H-B. Fentanyl-induced cough does not depend on injection speed a randomized study. Acta Anaesthesiol Scand 2008 52(8) 1071-5. 

ABUSE A case report described a 50-year-old female who smoked fentanyl patches and developed pulmonary alveolar proteinosis characterised by 3 months of cough, sputum production and dyspnoea on exertion [33 ]. 

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