Ketorolac tromethamine pretreatment suppresses sufentanil-induced cough during general anesthesia induction: A prospective randomized controlled trial

- Ketorolac tromethamine pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a prospective randomized controlled trial.
- Background: To observe the effect of pretreatment with ketorolac tromethamine on sufentanil-induced cough in general anesthesia patients..
- Methods: A total of 102 patients were screened, and 90 patients were scheduled for elective surgery under general anesthesia.
- The 90 patients were randomly divided into two groups: the control group (C group) and the.
- Five minutes before anesthesia induction, the observation group was given ketorolac tromethamine 0.5 mg/kg intravenously within 3 s, while the control group was given the same amount of normal saline intravenously.
- The incidence of adverse reactions, including nausea and vomiting, dizziness, drowsiness, delay of recovery, restlessness in the recovery period, respiratory depression and postoperative incision pain, was analyzed..
- Results: Within 1 min after sufentanil injection, the incidence and severity of cough in the KT group was.
- significantly lower than that in the C group ( P <.
- At T0, T1, T2, T3 and T4, there were no significant differences in MAP, HR and SpO2 between the two groups ( P >.
- There was no significant difference in the dosage of sufentanil, propofol, remifentanil and vecuronium, the incidence of nausea and vomiting, the delay of recovery, dizziness, drowsiness or respiratory depression between the two groups ( P >.
- However, the incidence of restlessness and the number of patients with VAS scores >.
- 3 in the KT group were significantly lower than those in the C group ( P <.
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- Conclusion: Pretreatment with intravenous ketorolac tromethamine can significantly reduce the incidence of sufentanil-induced cough during induction of general anesthesia, which can also significantly reduce postoperative incision pain and restlessness during the recovery period..
- Keywords: Ketorolac tromethamine, Sufentanil, Cough response, General anesthesia.
- Sufentanil, commonly used in general anesthesia for its strong analgesic properties, can produce an irritating cough during intravenous induction [1, 2].
- Various agents, such as remifentanil, dexmedetomi- dine, magnesium sulfate, lidocaine, and dezocine, have been used to suppress cough during the induction of general anesthesia [5, 6].
- Therefore, it is a chal- lenge for anesthesiologists to find a safe and effective drug with fewer adverse reactions to inhibit the sufentanil-induced cough response during the induc- tion of general anesthesia..
- Ketorolac tromethamine is a new nonsteroidal anti- inflammatory and analgesic drug that is widely used in the short-term treatment of acute moderate and severe pain, including postoperative incision pain [10, 11].
- At present, the clinical effect and safety of ketorolac tro- methamine for suppressing sufentanil-induced cough during the induction of general anesthesia remain unclear..
- The purpose of this study was to investigate the effect- iveness of ketorolac tromethamine for treating the sufentanil-induced cough response by intravenous injec- tion prior to general anesthesia induction..
- This study was approved by the Institutional Research Ethics Committee of the Suqian People ’ s Hospital of Nanjing Drum-Tower Hospital Group, Suqian, Jiangsu, China.
- The trial was registered in the Chinese Clinical Trial Registry (No.
- The patients were scheduled for elective surgery under general anesthesia in Suqian People ’ s Hospital of Nanjing Drum-Tower Hospital Group from February 2020 to March 2020.
- In the operating room, noninvasive blood pressure (NBP), pulse oxygen saturation (SpO 2.
- 5 min before general anesthesia induction, KT group patients were given ketorolac tromethamine 0.5 mg/kg (diluted to 5 ml using normal saline) intravenously within 3 s, while those in the C group were given 5 ml of normal saline only.
- The ketorolac tromethamine or normal saline was prepared by a nurse anesthetist and administered by an experi- enced anesthesiologist who was blind to the procedure..
- General anesthesia was induced with a bolus of sufentanil 0.5 μ g/.
- The depth of general anesthesia was maintained under propofol 5 mg/kg/h, remifentanil 10 μg/kg/h and vecuronium 0.05 mg/kg/h and was adjusted based on the vital signs of the patients..
- T0, before pretreatment of ketorolac tromethamine or normal saline, i.e., the baseline value.
- The incidence of adverse reactions, including nausea and vomiting, dizziness, drowsiness, delay of recovery, restlessness in the recovery period and respiratory de- pression, was analyzed.
- In brief, the adverse reactions of the two groups were evaluated by professional anesthesi- ologists according to the following unified criteria: be- cause nausea and dizziness are subjective assessments, for the evaluation of nausea and dizziness, the patients (who had recovered from the anesthesia) were ques- tioned by the anesthesiologist and were recorded as hav- ing nausea and/or dizziness if the answer was “Yes”.
- The vomiting judgment was performed according to the pa- tient’s self-report and the anesthesiologist’s observation..
- Recovery delay referred to the patient’s consciousness not being recov- ered and the patient being unable to make correct re- sponses to external stimulation and language instruction 120 min after general anesthesia.
- Restlessness in the re- covery period was defined as the patients mood being more excited in the recovery period, even crying and be- ing restless, and the patients making strong movements that could not be comforted.
- The postoperative incision pain of the patients was evaluated by the VAS scoring method, with a score of 0–10.
- In our preliminary study, the incidence of cough elicited by 0.5 μg/kg sufentanil infused within 3 s was 31.8% (7/.
- 22), which was reduced to when ketorolac tromethamine pretreatment was performed.
- Among 102 patients, 5 patients refused to participate in the study, 4 patients had a history of hypertension, and 3 patients underwent a change in anesthesia protocol (Fig.
- The incidence and severity of cough within 1 min after sufentanil injection in the KT group was significantly lower than that in the C group (P <.
- There was no significant difference in the dosage of sufentanil, propofol, remifentanil and vecuronium be- tween the two groups (P >.
- 3 in the anesthesia recovery period in the KT group were significantly lower than those in the C group (P <.
- There were no significant differences in the incidences of nausea and vomiting, delay of recovery, dizziness, drowsiness or re- spiratory depression between the two groups (P >.
- The various incidence rates among different studies might be due to the different doses of sufentanil used and differences in concentration, administration rate, race and age [19].
- In a study by Agarwal et al., sufentanil 0.3 μg/kg injected over 5 s elicited cough in 15.8% of pa- tients, while in another study by Li et al., the incidence of cough was 37% after the injection of sufentanil 0.5 μg/.
- kg), the incidence of sufentanil-induced cough could be up to .
- sufentanil 0.5 μg/kg intravenously within 3 s before the operation in the C group.
- Within 1 min, the incidence of sufentanil-induced cough was 31.1%, which is similar to the conclusions of relevant research..
- Five minutes before anesthesia induction, intravenous ketorolac tromethamine 0.5 mg/kg pretreatment can sig- nificantly reduce the incidence of coughing reactions during the induction period in general anesthesia pa- tients and can significantly reduce restlessness in the re- covery period of patients, which increases safety..
- Many studies have been performed on the mechanism of the sufentanil-induced cough response, but the rele- vant mechanism is still not very clear [3–5].
- Allocated to the KT intervention group (n=45).
- Allocated to the C intervention group (n=45).
- Table 1 Demographic data and basic clinical characteristics of the patients in the two groups.
- Table 2 Incidence and severity of cough in the two groups Groups Incidence.
- of cough (n(%)).
- At present, there are few reports about ketorolac tro- methamine reducing the sufentanil-induced cough re- sponse.
- Considering that ketorolac tro- methamine is a nonsteroidal anti-inflammatory drug, the mechanism of a ketorolac tromethamine injection redu- cing the cough response may be related to the reduction of histamine release and other reasons [10]..
- Ketorolac tromethamine is a new nonsteroidal anti- inflammatory drug (NSAID).
- found that intravenous infusion of 30 mg ketorolac tromethamine can significantly improve moderate to severe pain in emergency patients [22].
- sug- gested that injection of ketorolac tromethamine before tracheal intubation can reduce the incidence of sore throat caused by endotracheal intubation from 71.6 to 21.1% [23].
- Compared with other NSAIDs, ketorolac tro- methamine has a weaker anti-inflammatory effect and stronger analgesic effect and has been widely used in the clinic [10, 24].
- In this study, ketorolac tromethamine sig- nificantly reduced the number of patients with VAS scores greater than 3.
- Pretreatment with a ketorolac tro- methamine injection also played a role in the recovery period of anesthesia, significantly reducing the postoper- ative incision pain of patients, and the incidence of.
- To evaluate the possible adverse reactions and safety of ketorolac tromethamine injection pretreatment, we compared the mean arterial pressure, heart rate and blood oxygen saturation values of the two groups of pa- tients at different time points.
- The results suggest that pretreatment with ketorolac tromethamine injection does not have adverse effects on the vital signs of patients.
- Additionally, the results showed that the incidence of nausea, delayed recovery, dizziness, drowsi- ness and respiratory depression was not significantly in- creased when ketorolac tromethamine was used in advance, making it safe for patients.
- However, the dosage of drugs used in this study was not large and was within the scope of reason- able use in the instructions.
- Under these premises, ketorolac tromethamine will not have a significant impact on the operation or postoperative bleeding..
- First, due to the limitation of objective conditions, we have Table 3 Comparison of MAP, HR and SpO2 values at different time points.
- Table 4 Comparison of anesthetic dosages between the two groups.
- Restlessness in the recovery period lt.
- not studied the mechanism of ketorolac tromethamine in inhibition of the cough response and cannot give more reasonable inferences about the relevant mecha- nisms.
- We describe the relevant effects objectively because there is no relevant report about ketorolac tro- methamine injection or other nonsteroidal drugs inhibit- ing sufentanil-induced cough.
- Second, the pretreatment dose of ketorolac tromethamine that was used (0.5 mg/.
- kg) may not be the most appropriate dose for ketorolac tromethamine to inhibit the sufentanil-induced cough response, but it was given according to the early postop- erative analgesic dose recommended in the drug instruc- tions [10].
- To determine whether pre- treatment with ketorolac tromethamine injection can re- duce the sufentanil-induced cough response, we still need a large sample and multicenter study..
- Pretreatment with intravenous ketorolac tromethamine 0.5 mg/kg can significantly reduce the incidence and se- verity of sufentanil-induced cough during induction of general anesthesia, which can also significantly and safely reduce postoperative incision pain and restlessness in the recovery period.
- This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors..
- This clinical trial was approved by the Institutional Research Ethics Committee of the Affiliated of Suqian People ’ s Hospital of Nanjing Drum- Tower Hospital Group, Suqian, Jiangsu, China.
- Effects of different priming doses of propofol on fentanyl-induced cough during anesthesia induction: a preliminary randomized controlled study.
- Effect of equivalent doses of fentanyl, sufentanil, and remifentanil on the incidence and severity of cough in patients undergoing abdominal surgery: a prospective, randomized, double-blind study.
- Dose-dependent attenuation by fentanyl on cough during emergence from general anesthesia.
- Dezocine attenuates fentanyl-induced cough in a dose-dependent manner-a randomized controlled trial.
- Comparison of fentanyl, Remifentanil, Sufentanil and Alfentanil in combination with Propofol for general anesthesia: a systematic review and meta-analysis of randomized controlled trials.
- Dezocine prevents sufentanil-induced cough during general anesthesia induction: a randomized controlled trial.
- Effects of pretreatment with a small dose of dexmedetomidine on sufentanil-induced cough during anesthetic induction.
- Intermediate but not low doses of aspirin can suppress angiotensin- converting enzyme inhibitor-induced cough.
- Ketorolac tromethamine - routes and clinical implications.
- A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial.
- Optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough suppression: a prospective randomized controlled trial.
- Can low dose of propofol effectively suppress fentanyl-induced cough during induction of anaesthesia? A double blind randomized controlled trial.
- Dexmedetomidine combined with general anesthesia provides similar intraoperative stress response reduction when compared with a combined general and epidural anesthetic technique.
- Effect of intravenous dezocine on fentanyl-induced cough during general anesthesia induction: a double-blinded, prospective, randomized, controlled trial.
- Preemptive use of small dose fentanyl suppresses fentanyl induced cough.
- Magnesium sulfate inhibits sufentanil- induced cough during anesthetic induction.
- Comparison of the incidence and severity of cough induced by sufentanil and fentanyl: a prospective, randomised, double-blind study.
- Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial.
- Ketorolac Tromethamine spray prevents Postendotracheal-intubation-induced sore throat after general anesthesia

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