Evaluating the efficacy of propofol in attenuating the cardiorespiratory response to extubation: single-blinded randomised placebo-controlled tria

Abstract

Background: Extubation at the end of general anaesthesia (GA) should be performed in a way that ensures patient comfort and  minimises cardiorespiratory changes to prevent harm. Several drugs have been shown to attenuate these changes during emergence.  This study aimed to investigate if a sub-hypnotic dose of propofol can produce such favourable peri-extubation conditions.

Methods: A total of 50 American Society of Anesthesia (ASA) physical status I–II patients (aged 18–70) undergoing elective abdominal or  pelvic surgery under GA with a volatile agent were randomly assigned to a propofol group (n = 28) or a control group (n = 22). At the end  of the surgery, once the minimal alveolar concentration reached 0.6, patients received either propofol 0.5 mg kg^-1 or an equivalent  volume of 0.9% normal saline intravenously (IV). The primary outcome was the incidence and severity of bucking and coughing observed  during emergence, with the assessment performed by a blinded anaesthetist. Haemodynamic parameters, airway responses, extubation  complications, and time to extubation were evaluated during the emergence period at predetermined intervals.

Results: The  demographic and clinical characteristics of the two groups were comparable before surgery. Results indicated the incidence and severity  of bucking at extubation were significantly lower in the propofol group (21.4%) compared to the control group (68.2%, p < 0.001).  Similarly, patients in the propofol group had significantly fewer heart rate (HR) (p = 0.031) and systolic blood pressure (BP) (p = 0.031)  changes at extubation.

Conclusion: The addition of propofol 0.5 mg kg-1 before extubation successfully attenuated cardiorespiratory  responses following GA in ASA Grade I–II adult patients undergoing elective abdominal or pelvic surgery, but did not reduce the overall  incidence of cough at extubation