Effect of propofol and sevoflurane on coughing in smokers and non-smokers
awakening from general anaesthesia at the end of a cervical spine surgery.
Author(s): Hans P(1), Marechal H, Bonhomme V.
Affiliation(s): Author information:
(1)University Department of Anaesthesia and Intensive Care Medicine, CHR de la
Citadelle, Bd du 12eme de Ligne 1, 4000 Liege, Belgium. pol.hans@chu.ulg.ac.be
Publication date & source: 2008, Br J Anaesth. , 101(5):731-7
BACKGROUND: Coughing during emergence from general anaesthesia may be
detrimental, particularly after cervical spine surgery. We compared the effect of
propofol or sevoflurane anaesthesia on the incidence and severity of coughing
during recovery in patients undergoing cervical spine surgery via an anterior
approach. As a secondary aim, we also evaluated the influences of smoking and
estimated residual anaesthetic agent concentrations on coughing.
METHODS: Thirty-four patients were enrolled in a randomized prospective,
double-blind study to receive either propofol (PPF) or sevoflurane (SEVO) for
maintenance of anaesthesia. The decision to perform tracheal extubation was based
on specified criteria, including resumption of spontaneous respiration and
consciousness. During emergence from anaesthesia and extubation, coughing was
observed and graded at predefined times.
RESULTS: The incidence of severe coughing was higher in the SEVO group than in
the PPF group (59% and 6%, respectively), and also in smokers than in non-smokers
(50% and 17%, respectively). The peak incidence of coughing was at tracheal
extubation. The probability of coughing was influenced by the estimated residual
concentration of anaesthetic agents at extubation, except for smokers in the SEVO
group who were at the highest risk of coughing.
CONCLUSIONS: The incidence of coughing after cervical spine surgery when tracheal
extubation is performed according to clinical criteria is lower after propofol
anaesthesia compared with sevoflurane anaesthesia. Smokers are at increased risk
of coughing, independently of the type of anaesthesia maintenance. Higher
residual concentrations of anaesthetic agents decrease the probability of
coughing, except for smokers anaesthetized with sevoflurane.
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