why fentanyl causes cough reflex?

[ketap]

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hi,i am not quiet used to have fentanyl as my premed before..i usually use lidocaine..yesterday,i used it, but the patient was coughing immediately after my nurse gave that bolus dose..i read it somewhere sometime ago (i can't remember in which book 🙁 ) that fentanyl and sulfentanyl indeed cause cough reflex but i can't find the answer yet...
so, why fentanyl cause cough reflex?
is it quiet common happened? and how do you reduce the incident?

my friend told me that he used to dilute the fentanyl to 10cc and he has no patient cough at all..can i do this? thx🙂

 

[ashkenazi1234]

Cords close. Like a bolus gives chest wall rigidity

 

[ketap]

Cords close. Like a bolus gives chest wall rigidity

hi,thx for responding but ...i don't understand..how can they cause closing cords?
so do you have any suggestion how to reduce its incidence?🙂
thx u..

warm regards,Ketap

 

[Idiopathic]

some have described pretreating with albuterol to prevent if you are really concerned

 

[Orin]

So I've never noticed this happen, but our practice is to push the Fentanyl right before/with induction, and almost always after the Midaz is on board.

"Fentanyl enhances the excitability of rapidly adapting receptors to cause cough via the enhancement of histamine release in the airways"
http://www.coughjournal.com/content/9/1/3

"The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing"
http://www.ncbi.nlm.nih.gov/pubmed/19889113

We conclude that pre-emptive use of fentanyl 25 microg, administered 1 min before bolus injection of fentanyl (125 or 150 microg), can effectively suppress fentanyl-induced cough.

There's also some literature regarding premeds ablating the cough, so using dexemetomidine, midaz, lidocaine, ephederine, priming dose of a paralytic, or maybe even propofol seems to reduce the incidence of it.

 

[ketap]

thx for the answers..i'll try those stuffs and next time i'll dilute it and inject it slower...hopefully i 'll get the best recipe 🙂

regards,ketap