Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2020

Open Access 01-12-2020 | Cough | Research article

Dexmedetomidine versus midazolam on cough and recovery quality after partial and total laryngectomy – a randomized controlled trial

Authors: Rui Xu, Yun Zhu, Yi Lu, Wenxian Li, Jie Jia

Published in: BMC Anesthesiology | Issue 1/2020

Login to get access

Abstract

Background

During emergence from anesthesia after partial and total laryngectomy, excessive airway reflex and systemic hypertension may lead to subcutaneous emphysema, hemorrhage or pneumothorax.

Methods

American Society of Anesthesiologist physical status III and IV male adults undergoing elective laryngectomy were recruited and randomly allocated to receive either dexmedetomidine (group D) or midazolam (group M). The primary outcome was incidence and severity of cough. Pulse oximetry results (SpO2), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were also recorded. The visual analog scale and the Ramsay sedation scale were recorded at the points of wakefulness and departure from the post-anesthesia care unit (PACU). Rescue analgesia consumption, the time of spontaneous breath recovery, duration of the PACU stay, and the incidence of adverse effects were also recorded.

Results

The prevalence of no coughing was significantly higher in group D than in group M at the points of wakefulness and departure. HR, SBP, and DBP were significantly lower in group D compared with group M, and SpO2 was significantly higher in group D than in group M at the moment of laryngectomy. Pain scores were lower in group D than in group M. The Ramsay score at the point of wakefulness was higher in group D than in group M. There was no difference in time to spontaneous breathing recovery, duration of the PACU stay, and incidence of adverse effects.

Conclusions

Compared with midazolam, dexmedetomidine is an effective alternative to attenuate coughing and hemodynamic changes with a low incidence of adverse events during emergence from anesthesia after partial and total laryngectomy.

Trial registration

NCT03918889, registered at clinicaltrials.gov, date of registration: March 28, 2019.
Appendix
Available only for authorised users
Literature
1.
Vokes EE, Weichselbaum RR, Lippman SM, Hong WK. Head and neck cancer. N Engl J Med. 1993;328:184–94.CrossRefPubMed
2.
Zhi L, Wenli W, Pengfei G, Pengcheng C, Wenxian C, Jiasheng L, et al. Laryngotracheal reconstruction with autogenous rib cartilage graft for complex laryngotracheal stenosis and/or anterior neck defect. Eur Arch Otorhinolaryngol. 2014;271:317–22.CrossRefPubMed
3.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.PubMed
4.
Liu C, Liu H, Wen Y, Huang H, Hao J, Lv Y, et al. Aspernolide A Inhibits the Proliferation of Human Laryngeal Carcinoma Cells through the Mitochondrial Apoptotic and STAT3 Signaling Pathways. Molecules. 2019;19(24):1074.CrossRef
5.
Kosałka J, Wawrzycka-Adamczyk K, Jurkiewicz P, Pawlik W, Milewski M, Musiał J. Cough-induced lung intercostal hernia. Pneumonol Alergol Pol. 2016;84:119–20.PubMed
6.
Guler G, Akin A, Tosun Z, Ors S, Esmaoglu A, Boyaci A. Single-dose dexmedetomidine reduces agitation and provides smooth extubation after pediatric adenotonsillectomy. Paediatr Anaesth. 2005;15:762–6.PubMed
7.
Kim H, Min KT, Lee JR, Ha SH, Lee WK, Seo JH, et al. Comparison of Dexmedetomidine and Remifentanil on airway reflex and hemodynamic changes during recovery after craniotomy. Yonsei Med J. 2016;57:980–6.PubMedPubMedCentral
8.
Reza M, Hasani V, Bagheri-aghdam A, Zamani MM, Pournajafian A, Rokhtabnak F, et al. Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: a randomized controlled trial. J Clin Anesth. 2016;33:514–20.
9.
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656–9.PubMedPubMedCentral
10.
Aksu R, Akin A, Biçer C, Esmaoğlu A, Tosun Z, Boyaci A. Comparison of the effects of dexmedetomidine versus fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: a double-blind, randomized, controlled study. Curr Ther Res Clin Exp. 2009;70:209–20.CrossRefPubMedPubMedCentral
11.
Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DGE. Pharmacological methods for reducing coughing on emergence from elective surgery after general anesthesia with endotracheal intubation: protocol for a systematic review of common medications and network meta-analysis. Syst Rev. 2019;8:32.CrossRefPubMedPubMedCentral
12.
Lee JS, Choi SH, Kang YR, Kim Y, Shim YH. Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial. Can J Anaesth. 2015;62:392–8.CrossRefPubMed
13.
Tobis JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8:111–31.
14.
Liu X, Rabin PL, Yuan Y, Kumar A, Vasallo P, Wong J, et al. Effects of anesthetic and sedative agents on sympathetic nerve activity. Heart Rhythm. 2019;16:1875–82.
15.
Watanabe Y, Higuchi H, Ishii-Maru M, Honda Y, Yabuki-Kawase A, Yamane-Hirano A, et al. Effect of a low dose of midazolam on high blood pressure in dental patients: a randomised, double-blind, placebo-controlled, two-center study. Br J Oral Maxillofac Surg. 2016;54:443–8.CrossRefPubMed
16.
Gao JM, Meng XW, Zhang J, Chen WR, Xia F, Peng K, et al. Dexmedetomidine protects Cardiomyocytes against hypoxia/Reoxygenation injury by suppressing TLR4-MyD88-NF-κB signaling. Biomed Res Int. 2017;2017:1674613.PubMedPubMedCentral
17.
Chen Q, Wu W, Zhang GC, Cao H, Chen LW, Hu YN, et al. Dexmedetomidine attenuates hypoxemia during palliative reconstruction of the right ventricular outflow tract in pediatric patients. Medicine (Baltimore). 2014;93:e69.CrossRef
18.
Miller KA, Harkin CP, Bailey PL. Postoperative tracheal extubation. Anesth Analg. 1995;80:149–72.PubMed
19.
Patel SB, Kress JP. Sedation and analgesia in the mechanically ventilated patient. Am J Respir Crit Care Med. 2012;185:486–97.CrossRefPubMed
20.
Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8:115–31.PubMed
21.
Fraser GL, Devlin JW, Worby CP, Alhazzani W, Barr J, Dasta JF, et al. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill adults: a systematic review and meta-analysis of randomized trials. Crit Care Med. 2013;41:S30–8.PubMed
22.
Mom T, Bazin JE, Commun F, Dubray C, Eschalier A, Derbal C, et al. Assessment of postoperative pain after laryngeal surgery for cancer. Arch Otolaryngol Head Neck Surg. 1998;124:794–8.PubMed
23.
24.
Kowalski S, Macaulay K, Thorkelsson R, Girling L, Bshouty Z. Assessment of cough strength in patients with a tracheostomy. Can J Anaesth. 2017;64:1284–5.PubMed
25.
Di Santo D, Bondi S, Giordano L, Galli A, Tulli M, Ramella B, et al. Long-term swallowing function, pulmonary complications, and quality of life after Supracricoid Laryngectomy. Otolaryngol Head Neck Surg. 2019;12:194599819835189.
26.
Porceddu SV, Haddad RI. Management of elderly patients with locoregionally confined head and neck cancer. Lancet Oncol. 2017;18:e274–83.PubMed
Metadata
Title
Dexmedetomidine versus midazolam on cough and recovery quality after partial and total laryngectomy – a randomized controlled trial
Authors
Rui Xu
Yun Zhu
Yi Lu
Wenxian Li
Jie Jia
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-020-01168-7

Other articles of this Issue 1/2020

BMC Anesthesiology 1/2020 Go to the issue

Research article

Dexmedetomidine for prevention of postoperative pulmonary complications in patients after oral and maxillofacial surgery with fibular free flap reconstruction:a prospective, double-blind, randomized, placebo-controlled trial

Research article

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

Research article

Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial

Research article

Supreme™ laryngeal mask airway insertion requires a lower concentration of sevoflurane than ProSeal™ laryngeal mask airway insertion during target-controlled remifentanil infusion: a prospective randomised controlled study

Research article

Retrospective evaluation of pain in patients with coccydynia who underwent impar ganglion block

Research article

LMA Gastro™ airway is feasible during upper gastrointestinal interventional endoscopic procedures in high risk patients: a single-center observational study