Transcutaneous electrical acupoint stimulation before induction of anesthesia reduces sufentanil-induced cough: a randomized, controlled trial

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

[1] 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.

[2] Yu M, Kim JY, Kim HY. Intravenous dexamethasone pretreatment reduces remifentanil induced cough. Korean Journal of Anesthesiology. 2011; 60: 403.

[3] 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.

[4] 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.

[5] 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.

[6] 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.

[7] 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.

[8] Lui PW, Hsing CH, Chu YC. Terbutaline inhalation suppresses fentanyl-induced coughing. Canadian Journal of Anaesthesia. 1996; 43: 1216-1219.

[9] 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.

[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.

[11] Li M, Zhang X, Bao H, Li C, Zhang P. Acupuncture for asthma: protocol for a systematic review. Medicine. 2017; 96: e7296.

[12] 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.

[13] 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.

[14] 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.

[15] 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.

[16] 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.

[17] 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.

[18] 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.

[19] 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.

[20] 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.

[21] 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.

[22] 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.

[23] Han J. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences. 2003; 26: 17- 22.

[24] Phua WT, Teh BT, Jong W, Lee TL, Tweed WA. Tussive effect of a fentanyl bolus. Canadian Journal of Anaesthesia. 1991; 38: 330-334.

[25] Kamei J. Role of opioidergic and serotonergic mechanisms in cough and antitussives. Pulmonary Pharmacology. 1996; 9: 349-356.

[26] 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)