Abstract
Objectives: To evaluate the effect of injection of subhypnotic dose of propofol on postextubation
laryngospasm and cough following both total intravenous anesthesia (TIVA)
and general inhalational anesthesia. Patients & Methods: The study included 120
patients divided randomly into 2 equal groups: Inhalational group assigned to receive
inhalational anesthesia with no propofol for either induction or prior to extubation and
TIVA group assigned to receive TIVA. After extubation, the frequency and severity of
laryngospasm and cough within 2 minutes after extubation were recorded. All patients
developed post-extubation manifestations received positive pressure ventilation (PPV)
using facemask and if 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 TIVA group and 42 patients (70%) in
Inhalational group with significantly higher frequency of occurrence and higher severity
scores of cough in Inhalational compared to TIVA group. Sixty-one (50.8%) patients
developed post-extubation laryngospasm; 24 patients (40%) in TIVA group and 37
patients (61.7%) in Inhalational group with significantly higher frequency of occurrence
and severity of laryngospasm in Inhalational. 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, 9 patients required a second
propofol dose while 2 patients required re-intubation and oxygenation and readministered
a 3rd dose of propofol prior to re-extubation which was conducted safely
with significantly higher frequency of the need for the subhypnotic dose of propofol
with inhalational anesthesia compared to TIVA. Conclusion: Propofol-based TIVA
could minimize but not prevent post-extubation cough and laryngospasm compared to
balanced inhalational anesthesia. Subhypnotic dose of propofol (0.8 mg/kg) could be
used as adjunct to PPV as a therapeutic modality for spasm and cough with a success
rate of 93.3% of laryngospasm relief.
Keywords: Propofol, Subhypnotic dose, Post-extubation, Laryngospasm, Cough. |
