Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparing the Effects of Low Doses of Propofol, Ketamine and Combination of Propofol-Ketamine in Prevention of Post-Extubation Coughing and Laryngospasm

Document Type : Original Article (s)

Authors
Azim Honarmand 1
Mehdi Khazaei 2
Mohammadreza Safavi Homami 1
1 Associate Professor, Department of Anesthesiology and Critical Care, School of Medicine AND Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Anesthesiology and Critical Care Research Center AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: One of the most common complications in patients awakening from general anesthesia is post-extubation coughing. Laryngospasm, as a complication too, can result in severe outcomes. This study was conducted to compare the effect of small doses of propofol, ketamine and their combination on incidence and severity of post-extubation coughing and laryngospasm.Methods: Patients, who were scheduled to undergo operations under general anesthesia, were randomly divided in 4 groups of 40. Routine anesthesia was performed. Patients received 0.25 mg/kg propofol, 0.25 mg/kg ketamine, 0.25 mg/kg propofol, and 0.25 mg/kg ketamine and 0.1 ml/kg normal saline in propofol, ketamine, propofol-ketamine and control groups, respectively. Drugs were administered before extubation. Coughing and laryngospasm was recorded and graded at previously defined times during emergence from anesthesia.Findings: The incidence of coughing was 23 cases (57.5%) in propofol, 28 cases (70%) in ketamin, 11 cases (27.5%) in propofol-ketamine, and 33 cases (82.5%) in control group. The differences between the propofol-ketamine and other 3 groups and between the propofol and control groups were significant (P < 0.050). But, no significant differences were noted between the propofol and ketamine groups (P = 0.356) and between the ketamine and control groups (P = 0.121). Comparing the incidence of sever coughing (grade 3), the differences between the propofol-ketamine (no patients) and propofol (4 patients) (P = 0.040) and control (7 patients) (P = 0.006) groups were significant. No significant difference was noted between the groups in frequency of laryngospasm (P < 0.050).Conclusion: It could be concluded that the combination of low-dose propofol and ketamine could decrease the incidence and the severity of post-extubation coughing. Propofol could decrease this incidence, too (although less than combination).
Keywords
Cough
Ketamine
Propofol
General anesthesia
Laryngospasm
  1. Pak HJ, Lee WH, Ji SM, Choi YH. Effect of a small dose of propofol or ketamine to prevent coughing and laryngospasm in children awakening from general anesthesia. Korean J Anesthesiol 2011; 60(1): 25-9.
  2. Irwin RS. Complications of cough : ACCP evidence-based clinical practice guidelines. Chest 2006; 129(Suppl 1): 54S-8S.
  3. Koga K, Asai T, Vaughan RS, Latto IP. Respiratory complications associated with tracheal extubation. Timing of tracheal extubation and use of the laryngeal mask during emergence from anaesthesia. Anaesthesia 1998; 53(6): 540-4.
  4. Neelakanta G, Miller J. Minimum alveolar concentration of isoflurane for tracheal extubation in deeply anesthetized children. Anesthesiology 1994; 80(4): 811-3.
  5. Lee MG, Chang YJ, Park JM, Park HY. The clinical effective dose of alfentanil for suppressing cough during emergence from desflurane anesthesia. Korean J Anesthesiol 2011; 61(4): 292-6.
  6. Minogue SC, Ralph J, Lampa MJ. Laryngotracheal topicalization with lidocaine before intubation decreases the incidence of coughing on emergence from general anesthesia. Anesth Analg 2004; 99(4): 1253-7, table.
  7. Saghaei M, Reisinejad A, Soltani H. Prophylactic versus therapeutic administration of intravenous lidocaine for suppression of post-extubation cough following cataract surgery: a randomized double blind placebo controlled clinical trial. Acta Anaesthesiol Taiwan 2005; 43(4): 205-9.
  8. Alalami AA, Ayoub CM, Baraka AS. Laryngospasm: review of different prevention and treatment modalities. Paediatr Anaesth 2008; 18(4): 281-8.
  9. Visvanathan T, Kluger MT, Webb RK, Westhorpe RN. Crisis management during anaesthesia: laryngospasm. Qual Saf Health Care 2005; 14(3): e3.
  10. Roy WL, Lerman J. Laryngospasm in paediatric anaesthesia. Can J Anaesth 1988; 35(1): 93-8.
  11. Murphy PJ, Langton JA, Barker P, Smith G. Effect of oral diazepam on the sensitivity of upper airway reflexes. Br J Anaesth 1993; 70(2): 131-4.
  12. Sanikop C, Bhat S. Efficacy of intravenous lidocaine in prevention of post extubation laryngospasm in children undergoing cleft palate surgeries. Indian J Anaesth 2010; 54(2): 132-6.
  13. Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO. The use of magnesium to prevent laryngospasm after tonsillectomy and adenoidectomy: a preliminary study. Paediatr Anaesth 2003; 13(1): 43-7.
  14. Nishino T, Yonezawa T, Honda Y. Modification of laryngospasm in response to changes in PaCO2 and PaO2 in the cat. Anesthesiology 1981; 55(3): 286-91.
  15. Sundman E, Witt H, Sandin R, Kuylenstierna R, Boden K, Ekberg O, et al. Pharyngeal function and airway protection during subhypnotic concentrations of propofol, isoflurane, and sevoflurane: volunteers examined by pharyngeal videoradiography and simultaneous manometry. Anesthesiology 2001; 95(5): 1125-32.
  16. Brown RH, Wagner EM. Mechanisms of bronchoprotection by anesthetic induction agents: propofol versus ketamine. Anesthesiology 1999; 90(3): 822-8.
  17. Guler G, Aksu R, Bicer C, Tosun Z, Boyaci A. Comparison of the effects of ketamine or lidocaine on fentanyl-induced cough in patients undergoing surgery: A prospective, double-blind, randomized, placebo-controlled study. Curr Ther Res Clin Exp 2010; 71(5): 289-97.
  18. Kim JY, Lee SY, Kim DH, Park SK, Min SK. Effect-site concentration of propofol for reduction of remifentanil-induced cough. Anaesthesia 2010; 65(7): 697-703.
  19. Sedighinejad A, Naderi NB, Haghighi M, Imantalab V, Hadadi S, Erfani SR, et al. Propofol is Effective to Depress Fentanyl-Induced Cough during Induction of Anesthesia. Anesth Pain Med 2013; 2(4): 170-3.
  20. Yeh CC, Wu CT, Huh BK, Lee MS, Lin SL, Sheen J, et al. Premedication with intravenous low-dose ketamine suppresses fentanyl-induced cough. J Clin Anesth 2007; 19(1): 53-6.
  21. Batra YK, Ivanova M, Ali SS, Shamsah M, Al Qattan AR, Belani KG. The efficacy of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children. Paediatr Anaesth 2005; 15(12): 1094-7.
  22. Jung SY, Park HB, Kim JD. The effect of a subhypnotic dose of propofol for the prevention of coughing in adults during emergence from anesthesia with sevoflurane and remifentanil. Korean J Anesthesiol 2014; 66(2): 120-6.
  23. Leicht P, Wisborg T, Chraemmer-Jorgensen B. Does intravenous lidocaine prevent laryngospasm after extubation in children? Anesth Analg 1985; 64(12): 1193-6.
  24. Estebe JP, Dollo G, Le CP, Le NA, Chevanne F, Le VR, et al. Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena. Anesth Analg 2002; 94(1): 227-30, table.
  25. Kim ES, Bishop MJ. Cough during emergence from isoflurane anesthesia. Anesth Analg 1998; 87(5): 1170-4.
  26. Widdicombe JG. Afferent receptors in the airways and cough. Respir Physiol 1998; 114(1): 5-15.
  27. Fink BR. The etiology and treatment of laryngeal spasm. Anesthesiology 1956; 17(4): 569-77.
  28. Hans P, Marechal H, Bonhomme V. Effect of propofol and sevoflurane on coughing in smokers and non-smokers awakening from general anaesthesia at the end of a cervical spine surgery. Br J Anaesth 2008; 101(5): 731-7.
  29. McKeating K, Bali IM, Dundee JW. The effects of thiopentone and propofol on upper airway integrity. Anaesthesia 1988; 43(8): 638-40.
  30. Afshan G, Chohan U, Qamar-Ul-Hoda M, Kamal RS. Is there a role of a small dose of propofol in the treatment of laryngeal spasm? Paediatr Anaesth 2002; 12(7): 625-8.
  31. Fodale V, Pratico C, Leto G, Caminiti V, Mazzeo AT, Lucanto T. Propofol relieves post-extubation laryngospasm in obstetric anesthesia. Int J Obstet Anesth 2004; 13(3): 196-7.
  32. Jat KR, Chawla D. Ketamine for management of acute exacerbations of asthma in children. Cochrane Database Syst Rev 2012; 11: CD009293.
  33. Kabara S, Hirota K, Hashiba E, Yoshioka H, Kudo T, Sato T, et al. Comparison of relaxant effects of propofol on methacholine-induced bronchoconstriction in dogs with and without vagotomy. Br J Anaesth 2001; 86(2): 249-53.
  34. Church J, Jones MG, Davies SN, Lodge D. Antitussive agents as N-methylaspartate antagonists: further studies. Can J Physiol Pharmacol 1989; 67(6): 561-7.
Journal of Isfahan Medical School
Volume 32, Issue 297 - Serial Number 297
July and August 2014
Pages 1299-1309

  • Receive Date 11 August 2014
  • Accept Date 06 April 2022