Dexmedetomidine Versus Midazolam on Cough and Recovery Quality After Partial and Total Laryngectomy – a Randomized Controlled Trial

Abstract

Backgroundː During emergence from anesthesia after partial and total laryngectomy, excessive airway reflex and systemic hypertension may lead to pneumoderm, hemorrhage or pneumothorax. Methodsː ASA Ⅲ-Ⅳ male adults undergoing elective laryngectomy were recruited and randomly allocated to receive either dexmedetomidine or midazolam. The primary outcome was incidence and severity of cough. Pulse oximetry (SpO2 ), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. Visual Analogue Scale (VAS) and Ramsay sedation scale (RSS) were recorded at the point of awareness and departure from PACU. Rescue analgesia required consumption, time of spontaneous breath recovery, duration of the PACU stay, incidence of adverse effects were also recorded.Resultsː The prevalence of no coughing was significantly higher in group D than group M while the patients were at the point of awake and departure. Compared with group M, there was significant decrease in HR, SBP and DBP in group D than group M, and SpO2 was statistically significantly higher in group D than group M at the moment of laryngectomy. Pain scores were lower in group D than group M. The Ramsay score at awake in PACU was higher in group D than group M. There was no difference in time to spontaneous breathing recovery, duration of the PACU stayand incidence of adverse effects.Conclusionsː Compared with midazolam, dexmedetomidine is an effective alternative to attenuate coughing and hemodynamic changes with low incidence of adverse events during emergence for partial and total laryngectomy.Trial registration: NCT03918889, registered at clinicaltrials.gov, date of registration: March 28, 2019. Https://register.clinicaltrials.gov/prs/app/action/DownloadReceipt?uid=U0003V5T&ts=3&sid=S0008S19&cx=haixch