Leser fragen – Experten antworten – Hustenreiz nach intravenöser Applikation von Opioiden

Zusammenfassung

Gemäß der bislang verfügbaren Evidenz ist die mitunter zu beobachtende Induktion von Husten nach Applikation von Opioiden in letzter Konsequenz nicht geklärt. Die bekannten Opioidwirkungen lassen vielfältige Erklärungsmodelle zu, weswegen es in der Folge einer Opioidapplikation zum Hustenreiz kommt. Diese sind hier skizziert worden. Obgleich auch in Hinblick auf die Interventionen eine sehr heterogene Datenlage vorherrscht, weist die gegebene Literaturzusammenstellung doch auf klinisch praktikable Möglichkeiten hin, wie ein Hustenreiz nach Opiatgabe gemäß der besten zur Verfügung stehenden Evidenz zu vermeiden ist. Beispielhaft sind in diesem Zusammenhang nach gegenwärtigem Kenntnisstand die langsame Opioidgabe und die Vorgabe von Substanzen (z.B. Lidocain, Clonidin) zu nennen.

Abstract

The (intravenous) administration of opioids is frequently associated with the induction of cough. This phenomenon is usually neither harmful for the patient nor bothersome. However, in some situations a severe cough may interfere with imaging, diagnostic or therapeutic procedures and thus, anesthesiologists may want to know effective preventive measures. The existing literature is extremely diverse and the results of clinical trials are sometimes conflicting. Based on experimental investigations in accordance with clinical findings this systematic review of the existing evidence helps to guide the management strategy if opioid induced cough should be avoided. Promising strategies – among others – in order to achieve this aim consist for instance of decreasing the injection speed in conjunction with pre-administration of lidocaine or clonidine.

Schlüsselwörter:

Husten - Opioid - Fentanyl - Hustenreflex - Injektionsgeschwindigkeit

Keywords:

cough - opioids - fentanyl - cough reflex - injection speed

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