Comparison of the incidence and severity of cough after alfentanil and remifentanil injection

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Intravenous administration of fentanyl derivatives can induce cough paradoxically. This study examined the incidence and severity of cough after a bolus of alfentanil and remifentanil.


Four hundred and sixty-five patients, aged 18–70 years, were allocated randomly to three groups to receive alfentanil 10 μg/kg, remifentanil 1 μg/kg or an equal volume of 0.9% saline intravenously over 10 s. Any episode of cough was classified as coughing and graded as mild (1–2), moderate (3–4) or severe (5 or more).


The overall incidence of cough was higher in the opioid groups than in the saline group. The remifentanil group [39/150 patients; 26.0% (95% CI, 19.6–33.6%)] showed a higher incidence than the alfentanil group [11/152 patients; 7.2% (95% CI, 0.4–12.6%)] (P<0.001). There was no significant difference in the severity of cough between the alfentanil group and the remifentanil group.


This study demonstrated that equipotent boluses of alfentanil and remifentanil induced coughing, even though the incidence of cough after alfentanil administration was lower than that after remifentanil administration.

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