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BJA Advance Access originally published online on August 21, 2007
British Journal of Anaesthesia 2007 99(5):694-698; doi:10.1093/bja/aem228
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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

Cough reflex sensitivity after elective Caesarean section under spinal anaesthesia and after vaginal delivery

E. Gayat1, E. Lecarpentier1, S. Retout2, E. Bedairia1, A. Batallan3, M. Bonay4, J. Mantz5, P. Montravers1, J. M. Desmonts1 and J. Guglielminotti1,*

1 Département d’Anesthésie-Réanimation Chirurgicale
2 Département d’Epidémiologie, Biostatistique et Recherche Clinique
3 Service de Gynécologie-Obstétrique
4 Service des Explorations Fonctionnelles, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75018 Paris, France
5 Département d’Anesthésie-Réanimation Chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110 Clichy, France

* Corresponding author. E-mail: jean.guglielminotti{at}bch.ap-hop-paris.fr

Background: In pregnancy, airway oedema and heartburn may increase cough sensitivity, whereas spinal anaesthesia (SA) with local anaesthetics and opiates may decrease it. Decreased cough sensitivity increases the risk for pneumonia or retained secretions. The aim of this study was to determine whether cough sensitivity is increased in pregnant patients and if it is decreased after planned Caesarean section (CS) under SA.

Methods: Twenty-seven non-pregnant volunteers, 27 patients after vaginal delivery (VD group), and 28 patients after CS under SA (CS group) were studied. For SA, hyperbaric bupivacaine 8–12 mg, sufentanil 5 µg, and morphine 100 µg was given. Increasing concentrations of nebulized citric acid were delivered until eliciting cough. The concentration eliciting one (C1) and two coughs (C2) were recorded and log transformed for analysis (log C1 and log C2).

Results: Median (inter-quartile) log C1 was 1.3 (0.6) mg ml–1 in the VD group, 1.6 (0.6) mg ml–1 in the non-pregnant group (P < 0.01 vs VD group), and 2.2 (0.7) mg ml–1 in the CS group (P < 0.0001 and P < 0.01 vs VD and non-pregnant groups, respectively). Similar results were observed with log C2. In CS group, log C1 and log C2 remained increased up to 4 h after SA.

Conclusions: Cough sensitivity was increased after VD but decreased for up to 4 h after SA.

Keywords: anaesthesia, obstetric; anaesthetic techniques, subarachnoid; measurement techniques, airway reflexes; pregnancy; reflexes, threshold


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