Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia

Hohlrieder, Matthias; Tiefenthaler, Werner; Klaus, Hanna; Gabl, M.; Kavakebi, Pujan; Keller, Christian; Benzer, A.

doi:10.1093/bja/aem203

Cited by 81 publications

(60 citation statements)

References 30 publications

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“…Numerous strategies have been used to prevent haemodynamic responses caused by emergence from anaesthesia including extubation under deep anaesthesia, administration of local anaesthetics, vasodilators and short-acting opioids. 22 Administering vasodilators such as sodium nitroprusside, nitroglycerin, and hydralazine could be associated with complications like reflexive tachycardia and increase in the plasma renin activity. 23 Dexmedetomidine may be useful as an effective agent for blunting the adverse haemodynamic and recovery response to tracheal extubation.…”

Section: Discussionmentioning

confidence: 99%

Effect of Intravenous Dexmedetomidine on Haemodynamic and Recovery Response During Tracheal Extubation

Dutta¹,

Das²

2017

jemds

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BACKGROUND Dexmedetomidine, a highly selective alpha-2 agonist, has various beneficial effects like sedation, analgesia, attenuation of stress response with minimal cardiovascular instability or respiratory depression and may be a useful agent to facilitate smooth tracheal extubation.The aim of this study is to observe the effects of intravenous infusion of Dexmedetomidine in attenuating adverse haemodynamic and recovery response associated with tracheal extubation in patients operated under General Anaesthesia. METHODS AND MATERIALS120 patients were divided into two groups with 60 cases in each group by matching patient's age, sex, Mallampati and ASA grading and randomised with a sealed envelope and divided into two equal groups of 60 each namely group D and group C. Group D and C received an intravenous infusion of dexmedetomidine 0.75 mcg/kg or placebo respectively, over 15 minutes before anticipated time of end of surgery, Anaesthesia techniques were standardised. Heart rate, systolic, diastolic, mean arterial pressures were recorded while starting injection; at 1, 3, 5, 10, 15 minutes after starting injection; at the time of giving reversal; during extubation; at 1, 3, 5 minutes after extubation; and thereafter every 5 minutes for 15 minutes. Quality of extubation was evaluated on a 5-point scale and postoperative sedation on a 6-point scale. Any event of laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension, undue sedation was noted. Statistical Analysis-Descriptive data presented as Mean ± SD and in percentage. Pair wise comparison between the groups was done by Student's unpaired t-test. For Qualitative data, Chi-square test was used. Fisher's exact test was used to determine p-value of frequency of complication. P-value<0.05 is considered significant. RESULTSHeart rate, systolic, diastolic, mean arterial pressures were significantly higher in group C (P <0.05). Extubation quality score of majority of patients was 2 in group D and 3 in group C. Sedation score of most patients was 3 in group D and 2 in group C. Bradycardia was higher in group D. One patient in group D, two patients in group C had vomiting. CONCLUSIONDexmedetomidine 0.75 mcg/kg administered 15 minutes before extubation stabilises haemodynamics and facilitates smooth extubation. KEYWORDSAlpha-2-agonist, Dexmedetomidine, Extubation, Haemodynamics.HOW TO CITE THIS ARTICLE: Dutta G, Das N. Effect of intravenous dexmedetomidine on haemodynamic and recovery response during tracheal extubation.

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Section: Discussionmentioning

confidence: 99%

Effect of Intravenous Dexmedetomidine on Haemodynamic and Recovery Response During Tracheal Extubation

Dutta¹,

Das²

2017

jemds

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“…This may be explained because of the use of propofol and the larger dose of fentanyl administered during operations, which reduced stimulation during extubation. Hohlrieder et al 11 found that TIVA is associated with significantly less coughing and reduces hemodynamic response when compared with inhalation anesthesia in elective lumbar disc surgery during emergence from anesthesia. In addition, Wang et al 21 demonstrated more stable hemodynamics in the TCI patient group and significantly lower mean arterial pressure and faster recovery profiles compared with the fentanyl/DES patient group.…”

Section: Discussionmentioning

confidence: 99%

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Lin

Lee³

et al. 2016

SPI

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OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.

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“…In order to prevent a high dynamic response and choking in the recovery process of general anesthesia and extubation, many methods, such as deep anesthesia extubation, the use of local anesthetics, vasodilators, short-acting opioid drugs, and other methods, have been used in the clinic (Shajar et al, 1999;Hohlrieder et al, 2007). Studies have reported that the application of general anesthesia with propofol or remifentanil could make the recovery process of patients smoother (Shajar et al, 1999;Wilhelm et al, 2001;Blayney et al, 2003;Hohlrieder et al, 2007). However, propofol and remifentanil, which are more conducive to allowing patients to pass through the recovery period safely, have been less characterized.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially common in patients with obesity, hypertension, or cardiovascular disease, and can lead to fatal consequences. In order to prevent the highly dynamic response and choking during the extubation period after general anesthesia, many methods such as deep anesthesia extubation, the use of local anesthetics, vasodilators, short-acting opioid drugs, and other methods have been used in the clinic (Hohlrieder et al, 2007). Propofol, an intravenous anesthetic commonly used in the clinic, has a good sedative effect.…”

Section: Introductionmentioning

confidence: 99%

“…It has been widely used in clinical anesthesia (Hughes et al, 1992;Kapila et al, 1995;Soltesz et al, 2001). Recent studies have shown that the use of remifentanil can benefit patients who are awake (Shajar et al, 1999;Wilhelm et al, 2001;Hohlrieder et al, 2007). The purpose of this study was to investigate the effect of maintaining an intravenous infusion of remifentanil or propofol on the performance of general anesthesia, including the cardiovascular response, choking, and irritability at the end of general anesthesia, in order to assess the effect of a maintenance intravenous infusion of remifentanil or propofol.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia

Zhao

Jin

et al. 2014

Genet. Mol. Res.

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Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia

Abstract: During emergence from anaesthesia in the knee-elbow position, TIVA is associated with significantly less coughing and reduced haemodynamic response when compared with BAL.

Cited by 81 publications

References 30 publications

Effect of Intravenous Dexmedetomidine on Haemodynamic and Recovery Response During Tracheal Extubation

Effect of Intravenous Dexmedetomidine on Haemodynamic and Recovery Response During Tracheal Extubation

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Effects of maintaining intravenous infusion of remifentanil or propofol on anesthesia and palinesthesia during anesthesia and analepsia

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