Anesthesia & Clinical Research
Open Access

Abstract

BIS-Guided Sedation and Prevention of Cough Reaction in Patients with General Anesthesia Caused by Extubation: A Randomised Controlled Trial

Erfei Zhang*, Xiaoying Zhao, Xiaoyan AN, Min Wang, Jie Gao, Hailiang Zhang and Ying Li

Background: The multiple modes of SARS-CoV-2 transmission including airborne, droplet, contact, and fecal–oral transmissions that cause coronavirus disease 2019 (COVID-19) contribute to a public threat to the lives of people worldwide. Heavy aerosol production by coughing and the big peak expiratory flow during recovery from general anaesthesia in patients with respiratory infections (especially COVID-19) are the highest risk factors for infection in healthcare workers. To perform sedation before extubation significantly reduced the incidence of choking reactions during recovery from general anesthesia. However, there are few studies on endotracheal tube removal with BIS-guided sedation in PACU. We speculated that the BIS-guided sedation with dexmedetomidine and propopfol would better prevent coughing responses caused by tracheal extubation.

Methods: A total of 101 patients with general anaesthesia were randomly assigned to Group S (51 cases, dexmedetomidine was infused in the operating room for 30 minutes, and the Bispectral Index (BIS) value in was maintained 60-70 by infusion propofol at 0.5 ^~ 1.5 µg/ml in the PACU until the endotracheal tubes were pulled out) and Group C (50 cases, no dexmedetomidine and propofol treatment, replaced with the saline treatment). The incidence of coughing, agitation and active extubation, endotracheal tube tolerance and the peak expiratory flow at spontaneous breathing and at extubation were asessed.

Results: The incidence of coughing, agitation and active extubation were significantly lower in Group S than in Group C (P<0.05 or P<0.01, respectively); the scores of cough was significantly reduced in Group S than in Group C (P<0.01); the endotracheal tube tolerance was significantly improved in Group S than in Group C (P<0.001). And the peak expiratory flow at spontaneous breathing and at extubation was significantly reduced in Group S than in Group C.

Trial registration: Chinese Clinical Trial Registry: ChiCTR2200058429 (registration date: 09-04-2022) “retrospectively registered”.

Conclusion: BIS-guided sedation with dexmedetomidine and propopfol significantly prevented cough and reduced peak expiratory flow during recovery from general anaesthesia, which may play an important role in preventing medical staff from contracting COVID-19.

Published Date: 2022-11-04; Received Date: 2022-10-03