Comparing the Effects of Low Doses of Propofol, Ketamine and Combination of Propofol-Ketamine in Prevention of Post-Extubation Coughing and Laryngospasm



Honarm A¹ ; Khazaei M² ; Safavihomami M¹
Source: Journal of Isfahan Medical School Published:2014

Abstract

Background: One of the most common complications in patients awakening from general anesthesia is post-extubation coughing. Laryngospasm, as a complication too, can result in severe outcomes. This study was conducted to compare the effect of small doses of propofol, ketamine and their combination on incidence and severity of post-extubation coughing and laryngospasm. Methods: Patients, who were scheduled to undergo operations under general anesthesia, were randomly divided in 4 groups of 40. Routine anesthesia was performed. Patients received 0.25 mg/kg propofol, 0.25 mg/kg ketamine, 0.25 mg/kg propofol, and 0.25 mg/kg ketamine and 0.1 ml/kg normal saline in propofol, ketamine, propofol-ketamine and control groups, respectively. Drugs were administered before extubation. Coughing and laryngospasm was recorded and graded at previously defined times during emergence from anesthesia. Findings: The incidence of coughing was 23 cases (57.5%) in propofol, 28 cases (70%) in ketamin, 11 cases (27.5%) in propofol-ketamine, and 33 cases (82.5%) in control group. The differences between the propofol-ketamine and other 3 groups and between the propofol and control groups were significant (P < 0.050). But, no significant differences were noted between the propofol and ketamine groups (P = 0.356) and between the ketamine and control groups (P = 0.121). Comparing the incidence of sever coughing (grade 3), the differences between the propofol-ketamine (no patients) and propofol (4 patients) (P = 0.040) and control (7 patients) (P = 0.006) groups were significant. No significant difference was noted between the groups in frequency of laryngospasm (P < 0.050). Conclusion: It could be concluded that the combination of low-dose propofol and ketamine could decrease the incidence and the severity of post-extubation coughing. Propofol could decrease this incidence, too (although less than combination). © 2014, Isfahan University of Medical Sciences(IUMS). All rights reserved.