Efficacy of a single dose of esmolol to prevent extubation-related complications during emergence from anesthesia: a randomized, double-blind, placebo-controlled trial

Metoprolol for prevention of bucking at orotracheal extubation: a double-blind, placebo-controlled randomised trial

“… 1 These reflex responses are initiated by activating irritant receptors in the tracheal mucosa, leading to a reflexive contraction of the airway smooth muscles and the stimulation of the cough reflex. 1 , 2 , 3 Approximately 40–70% of patients develop bucking and coughing in surgical procedures requiring general anaesthesia. 1 , 2 , 3 Bucking and coughing may lead to significant complications, including tachycardia, hypertension, higher intracranial and intraocular pressure (especially after craniotomies and eye procedures), wound dehiscence after laparotomy, laryngeal oedema, myocardial ischemia and increased surgical site bleeding.…”

“… 1 , 2 , 3 Approximately 40–70% of patients develop bucking and coughing in surgical procedures requiring general anaesthesia. 1 , 2 , 3 Bucking and coughing may lead to significant complications, including tachycardia, hypertension, higher intracranial and intraocular pressure (especially after craniotomies and eye procedures), wound dehiscence after laparotomy, laryngeal oedema, myocardial ischemia and increased surgical site bleeding. 1 , 2 , 3 , 4 In particular, cough during and after endotracheal tube removal may cause a ligature to slip or non-ligated small vessels to bleed profusely because of increased venous pressure.…”

“…Thus, bucking and coughing can increase the length of hospital stay, health-related costs and mortality. 1 , 2 , 5 …”

“…In this respect, beta-blockers are known to reverse sympathetic activation during acute stress, suggesting a potential role of this drug class in attenuating cardiovascular responses and decreasing the risk of harmful events after extubation. 2 , 7 , 8 We recently showed that treatment with esmolol, an ultrashort-acting intravenous beta-blocker, was associated with clinically relevant hemodynamic control after tracheal extubation, which might contribute to the reduction of respiratory reflexes such as bucking and coughing. 2 Here, we hypothesized that metoprolol, a beta-blocker with a longer half-life than esmolol, could also show favorable effects on cough and bucking after extubation.…”

“… 2 , 7 , 8 We recently showed that treatment with esmolol, an ultrashort-acting intravenous beta-blocker, was associated with clinically relevant hemodynamic control after tracheal extubation, which might contribute to the reduction of respiratory reflexes such as bucking and coughing. 2 Here, we hypothesized that metoprolol, a beta-blocker with a longer half-life than esmolol, could also show favorable effects on cough and bucking after extubation. In this respect, only a few randomized trials have explored the effects of metoprolol on the cardiovascular response after extubation, and none have examined the potential beneficial respiratory effects of metoprolol, specifically in relation to bucking and coughing.…”