Efficacy of a propofol bolus against placebo to prevent cough at emergence from general anesthesia with desflurane: a randomized controlled trial

Purpose Emergence from anesthesia is a critical period and cough can result in adverse effects. Propofol inhibits airway reflexes and when infused it reduces cough more than inhalation anesthesia does. We evaluated the effect of a propofol bolus given at emergence on the incidence of coughing following a desflurane-based anesthesia. Methods One hundred and fifty-four patients scheduled for elective surgery were prospectively randomized to propofol (0.5 mg·$ kg^{−1} $) or normal saline (NS) administered at the end of the surgery at 1 minimum alveolar concentration (MAC) of desflurane. A “no touch” emergence technique was used until extubation. The primary outcome was the incidence of cough at the discontinuation of desflurane (T0) and reaching a MAC adjusted for age ($ MAC_{age} $) of 0.15. Secondary outcomes included incidence and severity of cough until five minutes postextubation (T0–T5), time to extubation, nausea and vomiting, sedation, hemodynamic variations, postoperative hypoventilation, hypoxemia, and sore throat. Results We could not draw inferences on the incidence of cough between T0 and $ MAC_{age} $ of 0.15 because only 27/68 (40%) patients in the NS group and 13/73 (18%) patients in the propofol group regained consciousness before reaching a $ MAC_{age} $ of 0.15. There were no significant differences between the groups in coughing incidence and severity between T0 and T5 (NS group, 57/68 [84%] vs propofol group, 70/73 [96%] ). The mean time to extubation in the propofol group was prolonged by 3 min 27 sec (95% confidence interval, 1 min 7 sec to 4 min 47 sec; P < 0.001) and more vasopressors were used at emergence (P = 0.02). The incidence of respiratory complications, nausea and vomiting, agitation, and sedation were not different between groups. Conclusion In the present trial, a propofol bolus administered at emergence did not reduce the incidence of cough occurring between T0 and T5 following a desflurane-based general anesthesia compared with placebo. Trial registration ClinicalTrials.gov (NCT02932397); registered 13 October 2016..

Medienart:	Artikel

Erscheinungsjahr:	2023
Erschienen:	2023

Enthalten in:	Zur Gesamtaufnahme - volume:70
Enthalten in:	Canadian journal of anesthesia - 70(2023), 5 vom: 24. Feb., Seite 842-850

Sprache:	Englisch

Beteiligte Personen:	Ouellet, Marie-Félix [VerfasserIn] Moore, Alex [VerfasserIn] Williams, Stephan [VerfasserIn] Girard, François [VerfasserIn] Desroches, Julie [VerfasserIn] Ruel, Monique [VerfasserIn] Beaulieu, Pierre [VerfasserIn]

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Themen:	Cough Desflurane Emergence Propofol

Anmerkungen:	© Canadian Anesthesiologists' Society 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:	10.1007/s12630-023-02401-w

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PPN (Katalog-ID):	OLC2143704550