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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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24-02-2023 | Cough | Reports of Original Investigations

Efficacy of a propofol bolus against placebo to prevent cough at emergence from general anesthesia with desflurane: a randomized controlled trial

Authors: Marie-Félix Ouellet, MD, FRCPC, Alex Moore, MD, FRCPC, Stephan Williams, MD, PhD, FRCPC, François Girard, MD, FRCPC, Julie Desroches, PhD, Monique Ruel, RN, Pierre Beaulieu, MD, PhD, FRCA

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 5/2023

Abstract

Purpose

Emergence from anesthesia is a critical period and cough can result in adverse effects. Propofol inhibits airway reflexes and when infused it reduces cough more than inhalation anesthesia does. We evaluated the effect of a propofol bolus given at emergence on the incidence of coughing following a desflurane-based anesthesia.

Methods

One hundred and fifty-four patients scheduled for elective surgery were prospectively randomized to propofol (0.5 mg·kg⁻¹) or normal saline (NS) administered at the end of the surgery at 1 minimum alveolar concentration (MAC) of desflurane. A “no touch” emergence technique was used until extubation. The primary outcome was the incidence of cough at the discontinuation of desflurane (T0) and reaching a MAC adjusted for age (MAC_age) of 0.15. Secondary outcomes included incidence and severity of cough until five minutes postextubation (T0–T5), time to extubation, nausea and vomiting, sedation, hemodynamic variations, postoperative hypoventilation, hypoxemia, and sore throat.

Results

We could not draw inferences on the incidence of cough between T0 and MAC_age of 0.15 because only 27/68 (40%) patients in the NS group and 13/73 (18%) patients in the propofol group regained consciousness before reaching a MAC_age of 0.15. There were no significant differences between the groups in coughing incidence and severity between T0 and T5 (NS group, 57/68 [84%] vs propofol group, 70/73 [96%] ). The mean time to extubation in the propofol group was prolonged by 3 min 27 sec (95% confidence interval, 1 min 7 sec to 4 min 47 sec; P < 0.001) and more vasopressors were used at emergence (P = 0.02). The incidence of respiratory complications, nausea and vomiting, agitation, and sedation were not different between groups.

Conclusion

In the present trial, a propofol bolus administered at emergence did not reduce the incidence of cough occurring between T0 and T5 following a desflurane-based general anesthesia compared with placebo.

Trial registration

ClinicalTrials.gov (NCT02932397); registered 13 October 2016.

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Title: Efficacy of a propofol bolus against placebo to prevent cough at emergence from general anesthesia with desflurane: a randomized controlled trial
Authors: Marie-Félix Ouellet, MD, FRCPC
Alex Moore, MD, FRCPC
Stephan Williams, MD, PhD, FRCPC
François Girard, MD, FRCPC
Julie Desroches, PhD
Monique Ruel, RN
Pierre Beaulieu, MD, PhD, FRCA
Publication date: 24-02-2023
Publisher: Springer International Publishing
Keywords: Cough
Postoperative Nausea and Vomiting
Cough
Cough
Remifentanil
Agitation
General Anesthesia
Propofol
Desflurane
Sevoflurane
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 5/2023
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-023-02401-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Efficacy of a propofol bolus against placebo to prevent cough at emergence from general anesthesia with desflurane: a randomized controlled trial

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Trial registration

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