SUBHYPNOTIC DOSE OF PROPOFOL AS A THERAPEUTIC MODALITY FOR POST-EXTUBATION SPASM AND COUGH

To evaluate the effect of injection of subhypnotic dose of propofol on post-extubation laryngospasm and cough following both total intravenous anesthesia (TIVA) and general inhalational anesthesia. Patients Methods: The study included 120 patients divided randomly into 2 equal groups: Inhalational group assigned to receive inhalational anesthesia with no propofol for either induction or prior to extubation and TIVA group assigned to receive TIVA. After extubation, the frequency and severity of laryngospasm and cough within 2 minutes after extubation were recorded. All patients developed post-extubation manifestations received positive pressure ventilation (PPV) using facemask and if persisted a subhypnotic dose of propofol (0.8 mg/kg) was given in conjunction with PPV. Results: Seventy-three (60.8%) patients developed postextubation cough; 31 patients (51.7%) in TIVA group and 42 patients (70%) in Inhalational group with significantly higher frequency of occurrence and higher severity scores of cough in Inhalational compared to TIVA group. Sixty-one (50.8%) patients developed post-extubation laryngospasm; 24 patients (40%) in TIVA group and 37 patients (61.7%) in Inhalational group with significantly higher frequency of occurrence and severity of laryngospasm in Inhalational. PPV alone allowed relief of post-extubation manifestations in 43 of 49 patients, propofol subhypnotic dose in conjunction with PPV relieved laryngospasm and cough in 21 patients, 9 patients required a second propofol dose while 2 patients required re-intubation and oxygenation and re-administered a 3rd dose of propofol prior to re-extubation which was conducted safely with significantly higher frequency of the need for the subhypnotic dose of propofol with inhalational anesthesia compared to TIVA. Conclusion: Propofol-based TIVA could minimize but not prevent post-extubation cough and laryngospasm compared to balanced inhalational anesthesia. Subhypnotic dose of propofol (0.8 mg/kg) could be used as adjunct to PPV as a therapeutic modality for spasm and cough with a success rate of 93.3% of laryngospasm relief.