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Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting
Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incid...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733904/ https://www.ncbi.nlm.nih.gov/pubmed/36506515 http://dx.doi.org/10.3389/fphar.2022.1050847 |
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author | Qian, Yiling Huang, Zhifei Wang, Guilong Han, Jinghong Zhou, Difei Ding, Hailei Zhang, Xin |
author_facet | Qian, Yiling Huang, Zhifei Wang, Guilong Han, Jinghong Zhou, Difei Ding, Hailei Zhang, Xin |
author_sort | Qian, Yiling |
collection | PubMed |
description | Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incidence of choking or bucking reaction, which is defined as sufentanil-induced cough (SIC). Moreover, postoperative nausea and vomiting (PONV) is a common and stressful complication, which is also related to the usage of opioid. High incidence of PONV is reported in the patients with SIC. Hence, we sought to determine whether naloxone, an opioid antagonist, at low dose would decrease the incidences of SIC and PONV. 216 female patients undergoing gynecological laparoscopic operation (<2 h) under general anesthesia were recruited in this study, and randomly assigned into two groups: Group N (patients receiving naloxone and Group C (patients receiving vehicle). Sufentanil (0.5 μg/kg within 5 s) was given in anesthesia induction, and low-dose naloxone (1.25 μg/kg) or identical vehicle was initially injected 5 min prior to induction, with the incidence and severity of SIC estimated. Subsequently, naloxone or vehicle was continuously infused at the rate of 0.5 μg/kg/h in the initiation of operation until the end of the operation, and the transverse abdominal fascia block (TAP) was performed for postoperative analgesia. The PONV profiles such as incidence and the severity, grading, and the frequencies of antiemetic usage within 24 h were evaluated, with VAS scores and remedial measures for analgesia during the first 24 h postoperatively were recorded. Our results revealed that one bolus of low-dose naloxone prior to the induction significantly mitigated the incidence of SIC, and intraoperative continuous infusion of low-dose naloxone reduced the incidence and the severity of PONV, so that the postoperative VAS scores and further remedial analgesia were not altered. These results not only provide clinical solutions for prophylaxis of SIC and PONV, but also suggests that opioids may act as a key role in both SIC and PONV, whereas opioid antagonist may hit two tasks with one stone. Moreover, further investigations are required to address the underlying mechanism of SIC and PONV. Clinical Trial Registration: [www.chictr.org.cn], identifier [ChiCTR2200064865]. |
format | Online Article Text |
id | pubmed-9733904 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97339042022-12-10 Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting Qian, Yiling Huang, Zhifei Wang, Guilong Han, Jinghong Zhou, Difei Ding, Hailei Zhang, Xin Front Pharmacol Pharmacology Sufentanil, a potent opioid, serves as the first option for perioperative analgesia owing to its analgesic effect, long duration and stable hemodynamics, whereas its side effects frequently blunt its application. The intravenous (IV) injection of sufentanil during anesthesia induction has high incidence of choking or bucking reaction, which is defined as sufentanil-induced cough (SIC). Moreover, postoperative nausea and vomiting (PONV) is a common and stressful complication, which is also related to the usage of opioid. High incidence of PONV is reported in the patients with SIC. Hence, we sought to determine whether naloxone, an opioid antagonist, at low dose would decrease the incidences of SIC and PONV. 216 female patients undergoing gynecological laparoscopic operation (<2 h) under general anesthesia were recruited in this study, and randomly assigned into two groups: Group N (patients receiving naloxone and Group C (patients receiving vehicle). Sufentanil (0.5 μg/kg within 5 s) was given in anesthesia induction, and low-dose naloxone (1.25 μg/kg) or identical vehicle was initially injected 5 min prior to induction, with the incidence and severity of SIC estimated. Subsequently, naloxone or vehicle was continuously infused at the rate of 0.5 μg/kg/h in the initiation of operation until the end of the operation, and the transverse abdominal fascia block (TAP) was performed for postoperative analgesia. The PONV profiles such as incidence and the severity, grading, and the frequencies of antiemetic usage within 24 h were evaluated, with VAS scores and remedial measures for analgesia during the first 24 h postoperatively were recorded. Our results revealed that one bolus of low-dose naloxone prior to the induction significantly mitigated the incidence of SIC, and intraoperative continuous infusion of low-dose naloxone reduced the incidence and the severity of PONV, so that the postoperative VAS scores and further remedial analgesia were not altered. These results not only provide clinical solutions for prophylaxis of SIC and PONV, but also suggests that opioids may act as a key role in both SIC and PONV, whereas opioid antagonist may hit two tasks with one stone. Moreover, further investigations are required to address the underlying mechanism of SIC and PONV. Clinical Trial Registration: [www.chictr.org.cn], identifier [ChiCTR2200064865]. Frontiers Media S.A. 2022-11-18 /pmc/articles/PMC9733904/ /pubmed/36506515 http://dx.doi.org/10.3389/fphar.2022.1050847 Text en Copyright © 2022 Qian, Huang, Wang, Han, Zhou, Ding and Zhang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Qian, Yiling Huang, Zhifei Wang, Guilong Han, Jinghong Zhou, Difei Ding, Hailei Zhang, Xin Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
title | Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
title_full | Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
title_fullStr | Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
title_full_unstemmed | Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
title_short | Low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
title_sort | low-dose naloxone for prophylaxis of sufentanil-induced choking and postoperative nausea and vomiting |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9733904/ https://www.ncbi.nlm.nih.gov/pubmed/36506515 http://dx.doi.org/10.3389/fphar.2022.1050847 |
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