Subhypnotic dose of propofol as a therapeutic modality for postextubation spasm and cough

Abstract EN

Objectives To evaluate the effect of injection of a subhypnotic dose of propofol on postextubation laryngospasm and cough following both total intravenous anesthesia (TIVA) and general inhalational anesthesia.

Patients and methods The study included 120 patients divided randomly into two equal groups: the inhalation group and the TIVA group.

The inhalation group was assigned to receive inhalational anesthesia with no propofol for either induction or before extubation, and the TIVA group was assigned to receive TIVA.

After extubation, the frequency and severity of laryngospasm and cough within 2 min after extubation were recorded.

All patients who developed postextubation manifestations received positive pressure ventilation (PPV) using a face mask, and if the condition persisted a subhypnotic dose of propofol (0.8 mg/kg) was given in conjunction with PPV.

Results Seventy-three (60.8%) patients developed postextubation cough: 31 patients (51.7%) in the TIVA group and 42 patients (70%) in the inhalation group, with significantly higher frequency of occurrence and higher severity scores of cough in the inhalation compared with the TIVA group.

Sixty-one (50.8%) patients developed postextubation laryngospasm: 24 patients (40%) in the TIVA group and 37 patients (61.7%) in the inhalation group, with significantly higher frequency of occurrence and severity of laryngospasm in the inhalation group.

PPV alone allowed relief of postextubation manifestations in 43 of 49 patients; propofol subhypnotic dose in conjunction with PPV relieved laryngospasm and cough in 21 patients; nine patients required a second propofol dose, whereas two patients required reintubation and oxygenation and were readministered a third dose of propofol before reextubation, which was conducted safely with significantly higher need for the subhypnotic dose of propofol with inhalational anesthesia compared with TIVA.

Conclusion Propofol-based TIVA could minimize but not prevent postextubation cough and laryngospasm compared with balanced inhalational anesthesia.

Subhypnotic dose of propofol (0.8 mg/kg) could be used as an adjunct to PPV as a therapeutic modality for spasm and cough, with a success rate of 93.3% for laryngospasm relief