Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial
Restricted accessResearch articleFirst published online March, 2022
Comparison of the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm among patients awakening from general anaesthesia: A prospective randomised clinical trial
Coughing and laryngospasm are undesirable consequences occurring when patients awaken from general anaesthesia. The objective of the study aimed to compare the effects of intravenous propofol and propofol with low-dose ketamine on preventing postextubation cough and laryngospasm.
Methods
In all, 120 patients scheduled surgery under general anaesthesia were randomly assigned into three groups. Patients in the control group (C-group) received intravenous 0.9% NaCl, while patients in the propofol group (P-group) received intravenous 0.25mg/kg propofol and patients in the propofol combined with ketamine group (PK-group) received intravenous 0.25mg/kg of propofol plus 0.15mg/kg of ketamine. Drugs were administered before extubation. Incidence and severity of coughing and laryngospasm were recorded by a blinded anaesthesiologist.
Results
Subjects of the PK-group (25%) experienced significantly reduced incidence of postoperative cough than that in the P-group (55%) and C-group (72.5%) (all P < 0.05). The severity of cough in the PK-group was significantly less than that in the P-group and C-group (P = 0.039 and P < 0.001, respectively). No significant difference was found in the incidence and severity of laryngospasm between comparison groups.
Conclusion
Intravenous combination of propofol and low-dose ketamine significantly reduced the incidence and severity among patients awakening from general anaesthesia.
AfshanGChohanUQamar-Ul-HodaMKamalRS2002Is there a role of a small dose of propofol in the treatment of laryngeal spasm?Paediatric Anaesthesia12625–628
2.
AlalamiAAAyoubCMBarakaAS2008Laryngospasm: review of different prevention and treatment modalitiesPaediatric Anaesthesia18281–288
3.
AouadMTZeeniCAl NawwarRSiddik-SayyidSMBarakatHBEliasSYazbeck KaramVG2019Dexmedetomidine for improved quality of emergence from general anesthesia: a dose-finding studyAnesthesia & Analgesia129(6) 1504–1511
4.
BatraYKIvanovaMAliSSShamsahMAl QattanARBelaniKG2005The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in childrenPaediatric Anaesthesia151094–1097
5.
BehaeenKSoltanzadehMNesioonpourSEbadiAOlapourAAslaniSM2014Analgesic effect of low dose subcutaneous ketamine administration before and after cesarean sectionIranian Red Crescent Medical Journal16(3) e15506
6.
BrownRHWagnerEM1990Mechanisms of bronchoprotection by anesthetic induction agents: propofol versus ketamineAnesthesiology90822–828
7.
BurburanSMXistoDGRoccoPR2007Anaesthetic management in asthmaMinerva Anestesiologica73357–365
8.
ChurchJJonesMGDaviesSNLodgeD1989Antitussive agents as N-methylaspartate antagonists: further studiesCanadian Journal of Physiology and Pharmacology67561–567
9.
ElbersLPBSquizzatoA2018Thyroid disorders and hemostasisSeminars in Thrombosis Hemostasis44676–682
10.
FaganCFrizelleHPLaffeyJHannonVCareyM2000The effects of intracufflidocaine on endotracheal tube induced emergence phenomena after general anesthesiaAnesthesia & Analgesia91201–205
11.
FinkBR1956The etiology and treatment of laryngeal spasmAnesthesiology17569–577
12.
FodaleVPraticoCLetoGCaminitiVMazzeoATLucantoT2004Propofol relieves post-extubation laryngospasm in obstetric anesthesiaInternational Journal of Obstetric Anesthesia13196–197
13.
GonzalezRMBjerkeRJDrobyckiTStapelfeldtWHGreenJMJanowitzMJClarkM1994Prevention of endotracheal tube-induced coughing during emergence from general anesthesiaAnesthesia & Analgesia79792–795
14.
GulerGAkinATosunZEskitascogluEMizrakABoyaciA2005Single-dose dexmedetomidine attenuates airway and circulatory reflexes during extubationActa Anaesthesiologica Scandinavica49(8) 1088–1091
15.
GulerGAksuRBicerCTosunZBoyaciA2010Comparison of the effects of ketamine or lidocaine on fentanyl-induced cough in patients undergoing surgery: a prospective, double-blind, randomized, placebo-controlled studyCurrent Therapeutic Research, Clinical and Experimental71289–297
16.
HansPMarechalHBonhommeV2008Effect of propofol and sevofurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgeryBritish Journal of Anaesthesia101731–737
17.
HuSLiYWangSXuSJuXMaL2019Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgeryBMC Anesthesiology19(1) 66
18.
IrwinRS2006Complications of cough: ACCP evidence-based clinical practice guidelinesChest12954S–58S
19.
KimESBishopMJ1998Cough during emergence from isoflurane anesthesiaAnesthesia & Analgesia871170–1174
20.
KogaKAsaiTVaughanRSLattoIP1998Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesiaAnaesthesia53540–544
21.
LeeJSChoiSHKangYRKimYShimYH2015Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trialCanadian Journal of Anesthesia62392–398
22.
LeeMGChangYJParkJMParkHY2011The clinical effective dose of alfentanyl for suppressing cough during emergence from desfurane anesthesiaKorean Journal of Anesthesiology61292–296
23.
McKeatingKBaliIMDundeeJW1988The effects of thiopentone and propofol on upper airway integrityAnaesthesia43638–640
24.
MinogueSCRalphJLampaMJ2004Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesiaAnesthesia & Analgesia991253–1257
25.
MunjupongSMalaithongWMansumruatkanTChantrapannikEOofuvongM2019Efficacy of very low dose intravenous lidocaine in preventing cough and sore throat after awakening from general anesthesia: a randomized control trialJournal of the Medical Association of Thailand1021009–1015
26.
NathPWilliamsSHerrera MéndezLFMassicotteNGirardFRuelM2018Alkalinized lidocaine preloaded endotracheal tube cuffs reduce emergence cough after brief surgery: a prospective randomized trialAnesthesia & Analgesia126615–620
27.
NawfalMBarakaA2002Propofol for relief of extubation laryngospasmAnaesthesia571028–1044
28.
NeelakantaGMillerJ1994Minimum alveolar concentration of isoflurane for tracheal extubation in deeply anesthetized childrenAnesthesiology80811–813
29.
PakHJLeeWHJiSMChoiYH2011Effect of a small dose of propofol or ketamine to prevent coughing and laryngospasm in children awakening from general anesthesiaKorean Journal of Anesthesiology6025–29
30.
QuibellRPrommerEEMihalyoMTwycrossRWilcockA2014Ketamine*Journal of Pain and Symptom Management41(3) 640–649
31.
TabingAKEhrenfeldJMWandererJP2015Limiting the accessibility of cost-prohibitive drugs reduces overall anesthetic drug costs: a retrospective before and after analysisCanadian Journal of Anesthesia621045–1054
32.
SafaviMHonarmandAKhazaeiM2016The effects of propofol, ketamine and combination of them in prevention of coughing and laryngospasm in patients awakening from general anesthesia: a randomized, placebo-controlled, double blind clinical trialAdvanced Biomedical Research564
33.
SaghaeiMReisinejadASoltaniH2005Prophylactic versus therapeutic administration of intravenous lidocaine for suppression of post-extubation cough following cataract surgery: a randomized double blind placebo controlled clinical trialActa Anaesthesiologica Taiwanica43205–209
34.
SaidSIBerishaHIPakbazH1995N-methyl-D-aspartate receptors outside the central nervous system: activation causes acute lung injury that is mediated by nitric oxide synthesis and prevented by vasoactive intestinal peptideNeuroscience65943–946
35.
SundmanEWittHSandinRKuylenstiernaRBodénKEkbergOErikssonLI2001Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometryAnesthesiology951125–1132
36.
VisvanathanTKlugerMTWebbRKWesthorpeRN2005Crisis management during anaesthesia: laryngospasmQuality & Safety in Health Care14e3.
37.
YehCCWuCTHuhBKLeeMSLinSLJ SheenMWongCS2007Premedication with intravenous low-dose ketamine suppresses fentanyl-induced coughJournal of Clinical Anesthesia19(1) 53–56
