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BJA Advance Access originally published online on July 27, 2007
British Journal of Anaesthesia 2007 99(4):587-591; doi:10.1093/bja/aem203
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia

M. Hohlrieder1, W. Tiefenthaler1, H. Klaus1, M. Gabl2, P. Kavakebi2, C. Keller1 and A. Benzer1,*

1 Department of Anaesthesiology and Critical Care Medicine
2 Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria

* Corresponding author. E-mail: arnulf.benzer{at}uki.at

Background: The effects of total intravenous anaesthesia (TIVA) and balanced anaesthesia (BAL) on coughing during emergence from the general anaesthesia have not yet been compared.

Methods: Fifty patients, aged 18–60 yr, undergoing elective lumbar disk surgery were randomly allocated to undergo TIVA (propofol–remifentanil) or BAL (fentanyl–nitrous oxide–sevoflurane). Extubation was performed in the knee–elbow position, documented on video, and subsequently evaluated by blinded examiners.

Results: There was no difference between TIVA and BAL patients with respect to patient characteristics, proportion of smokers, surgical time, or time of emergence. The median number of coughs was significantly lower in the TIVA group (1, range 0–9) than in the BAL group (4, range 0–20, P = 0.007). Mean maximal heart rate and mean maximal arterial pressure measured during emergence were also significantly lower in the TIVA group (P = 0.009 and P = 0.006, respectively).

Conclusions: During emergence from anaesthesia in the knee–elbow position, TIVA is associated with significantly less coughing and reduced haemodynamic response when compared with BAL.

Keywords: airway; complications; anaesthetic techniques, inhalation; anaesthetic techniques, i.v. infusion; cough


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