Transcutaneous electrical acupoint stimulation before induction of anesthesia reduces sufentanil-induced cough: a randomized, controlled trial
1Department of Anesthesiology of First Aﬃliated Hospital of Wenzhou Medical University, P. R. China
2Department of Anesthesiology of Zhejiang Provincial People’s Hospital, P. R. China
3Department of Anesthesiology of Central Hospital of Lishui, P. R. China
4Department of Anesthesiology of Taizhou Hospital of Zhejiang Province, P. R. China
DOI: 10.22514/sv.2021.024 Vol.17,Issue 4,July 2021 pp.66-70
Submitted: 21 December 2020 Accepted: 19 January 2021
Published: 08 July 2021
Background: Sufentanil-induced cough is a common side effect during the induction of general anesthesia. This study sought to determine the inhibitory effect of TEAS (transcutaneous electrical acupoint stimulation) on the incidence of sufentanil-induced cough.
Methods: A total of 339 patients were recruited of which 300 patients were enrolled and randomly allocated into five groups (n = 60): Patients did not receive TEAS in the control group (C group); patients received 2 Hz TEAS at LI4/PC6 (Hegu/Neiguan) in the 2A group; patients received 100 Hz TEAS at LI4/PC6 in the 100A group; patients received 2 Hz TEAS at ST36/SP6 (Zusanli/sanyinjiao) in the 2B group; and patients received 100 Hz TEAS at ST36/SP6 in the 100B group. With the exception of the C group, all groups received TEAS for 30 minutes before induction. 0.5 µg/kg of IV sufentanil was given over 2 seconds, and the occurrence of cough was observed and recorded for 1 minute. The severity of cough was graded as mild (1-2 coughs), moderate (3-5 coughs), and severe (> 5 coughs). The mean arterial pressure (MAP) and heart rate (HR) before (T0) and 1 minute after (T1) sufentanil injection were recorded.
Results: The incidence of sufentanil-induced cough in C group, 2A group, 2B group, 100A group and 100B group were 37%, 27%, 27%, 12% and 13%, respectively. Compared with the C group, the incidence of cough in the 100A group and the 100B group were significantly lower (P < 0.05). The MAP and HR between the five groups were not statistically different.
Conclusion: The administration of 100 Hz TEAS for 30 minutes before sufentanil injection can effectively reduce the incidence of sufentanil-induced cough during the induction of general anesthesia.
Sufentanil; Cough; TEAS; General anesthesia
Jun-Jie Xie,Yun-Chang Mo,Jun-Kai Wang,Li-Li Yang,Hai-Juan He,Jun-Lu Wang. Transcutaneous electrical acupoint stimulation before induction of anesthesia reduces sufentanil-induced cough: a randomized, controlled trial. Signa Vitae. 2021. 17(4);66-70.
 Sun S, Huang S. Effects of pretreatment with a small dose of dexmedeto-midine on sufentanil-induced cough during anesthetic induction. Journal of Anesthesia. 2013; 27: 25-28.
 Yu M, Kim JY, Kim HY. Intravenous dexamethasone pretreatment reduces remifentanil induced cough. Korean Journal of Anesthesiology. 2011; 60: 403.
 Yao W, Wang T, Jiang B, Gao F, Wang L, Zheng H, et al. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. British Journal of Anaesthesia. 2020; 125: e28-e37.
 Lin C-, Sun W-, Chan W-, Lin C-, Yeh H-, Mok MS. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough. Canadian Journal of Anesthesia. 2004; 51: 654-659.
 Lin J, Chen F, Lee M, Horng H, Cherng C, Yeh C, et al. Intravenous dexamethasone pretreatment reduces fentanyl-induced cough. Journal of the Formosan Medical Association. 2007; 106: 649-655.
 Yeh C, Wu C, Huh BK, Lee M, Lin S, J Sheen M, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. Journal of Clinical Anesthesia. 2007; 19: 53-56.
 Horng H, Wong C, Hsiao K, Huh BK, Kuo C, Cherng C, et al. Pre-medication with intravenous clonidine suppresses fentanyl-induced cough. Acta Anaesthesiologica Scandinavica. 2007; 51: 862-865.
 Lui PW, Hsing CH, Chu YC. Terbutaline inhalation suppresses fentanyl-induced coughing. Canadian Journal of Anaesthesia. 1996; 43: 1216-1219.
 Cho S, Yang S, Shin HS, Lee SH, Koh JS, Kwon S, et al. Anti-inflammatory and immune regulatory effects of acupuncture after craniotomy: study protocol for a parallel-group randomized controlled trial. Trials. 2017; 18: 10.
 Wang J, Li J, Yu X, Xie Y. Acupuncture therapy for functional effects and quality of life in COPD patients: a systematic review and meta-analysis. BioMed Research International. 2018; 2018: 1-19.
 Li M, Zhang X, Bao H, Li C, Zhang P. Acupuncture for asthma: protocol for a systematic review. Medicine. 2017; 96: e7296.
 Jie L, Kai L. Effects of pre-inhalation of salbutamol on cough reflex induced by sufentanil (pp. 237-239). 2016 International Conference on Mechatronics, Control and Automation Engineering. Atlantis Press. 2016.
 An L, Gui B, Su Z, Zhang Y, Liu H. Magnesium sulfate inhibits sufentanil-induced cough during anesthetic induction. International Journal of Clinical and Experimental Medicine. 2015; 8: 13864-13868.
 Zhang R, Chen X, Chen Y. The mechanism, influential factors and prevention of cough reflex induced by fentanyl. International Journal of Anesthesiology and Resuscitation. 2006; 6: 369-372.
 Karlsson JA, Lanner AS, Persson CG. Airway opioid receptors mediate inhibition of cough and reflex bronchoconstriction in guinea pigs. The Journal of Pharmacology and Experimental Therapeutics. 1990; 252: 863- 868.
 Wang H, Xie Y, Zhang Q, Xu N, Zhong H, Dong H, et al. Transcutaneous electric acupoint stimulation reduces intra-operative remifentanil con-sumption and alleviates postoperative side-effects in patients undergoing sinusotomy: a prospective, randomized, placebo-controlled trial. British Journal of Anaesthesia. 2014; 112: 1075-1082.
 Hsing WT, Imamura M, Weaver K, Fregni F, Azevedo Neto RS. Clinical effects of scalp electrical acupuncture in stroke: a sham-controlled randomized clinical trial. Journal of Alternative and Complementary Medicine. 2012; 18: 341-346.
 Kim KH, Lee MS, Kim TH, Kang JW, Choi TY, Lee JD. Acupuncture and related interventions for symptoms of chronic kidney disease. Cochrane Database of Systematic Reviews. 2016: CD009440.
 Wen Y, Yeh G, Shyu B, Ling Q, Wang K, Chen T, et al. A minimal stress model for the assessment of electroacupuncture analgesia in rats under halothane. European Journal of Pain. 2007; 11: 733-742.
 Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC, et al. Effect of low-and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin a immunoreactivity in human lumbar CSF. Pain. 1991; 47: 295-298.
 Sun SL, Han JS. High and low frequency electroacupuncture analgesia are mediated by different types of opioid receptors at spinal level: a cross tolerance study. Acta Physiologica Sinica. 1989; 41: 416-420.
 Lee JH, Choi YH, Choi BT. The anti-inflammatory effects of 2 Hz electroacupuncture with different intensities on acute carrageenan-induced inflammation in the rat paw. International Journal of Molecular Medicine. 2005; 16: 99-102.
 Han J. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences. 2003; 26: 17- 22.
 Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive effect of a fentanyl bolus. Canadian Journal of Anaesthesia. 1991; 38: 330-334.
 Kamei J. Role of opioidergic and serotonergic mechanisms in cough and antitussives. Pulmonary Pharmacology. 1996; 9: 349-356.
 Wang L, Yao JH, Zhu JJ, Liu B, Zhu JG, Zhou DC. Effect of optimizing anesthetic injecting sequence during induction on fentanyl-induced coughing. Zhonghua Yi Xue Za Zhi. 2010; 90: 921-923. (In Chinese)
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