Comparative study between propofol and midazolam in treatment of postextubation laryngospasm

Abstract EN

Background Laryngospasm is the most common cause of airway obstruction after tracheal extubation.

Propofol is known to inhibit airway reflexes and is used in treating laryngospasm in subhypnotic doses.

Diazepam also decreases airway reflexes and was used in treating hysterical stridor.

In this study, we aimed to compare the effectiveness of both drugs in treating laryngospasm.

Patients and methods This study was conducted over a period of 3 years.

We enrolled 40 patients, 20 in each group, of American Society of Anesthesiologists (ASA) grades I and II, undergoing elective oropharyngeal surgeries.

Patients who received drugs before extubation such as lidocaine or a supplemental dose of narcotics were excluded from the study; patients of ASA grade III/IV, those above 60 years or below 12 years, and those with a full stomach were also excluded.

The anesthetic technique was the same in all patients.

Anesthesia was induced using 4 mg / kg thiopental, 0.5 mg/kg atracurium, and 1 µg / kg fentanyl.

A cuffed tracheal tube was inserted and the lungs were ventilated with oxygen and 1% isoflurane.

At the end of the surgery, residual neuromuscular blockade was antagonized.

The presence of laryngospasm after extubation was detected, and the patients were randomly allocated to either group P that received 0.5 mg / kg propofol intravenously or group M that received 0.03 mg / kg midazolam intravenously.

In both groups 100% O2 and manual ventilation was continued until the spasms were relieved and the saturation returned to normal.

Response of patients to both drug therapies was recorded.

The mean arterial pressure and heart rate were measured.

Results In the propofol group, 15 of 20 patients responded well to the dose of propofol, whereas in the midazolam group, 17 of 20 patients responded to treatment.

The other patients in the two groups, who were not relieved by either propofol or midazolam, were intubated after administration of succinylcholine.

There was a significant decrease in the mean arterial pressure and heart rate in both groups after administration of the study drugs, and this decrease was comparable and similar in both groups.

Conclusion In patients in whom the use of succinylcholine is contraindicated (as in those with burns or muscular dystrophy), propofol or midazolam can be an alternative option.