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Clinical Investigation:
J. Guglielminotti, T. Rackelboom, A. Tesniere, X. Panhard, F. Mentre, M. Bonay, J. Mantz, and J. M. Desmonts
Assessment of the cough reflex after propofol anaesthesia for colonoscopy
Br. J. Anaesth. 2005; 0: aei175v1 [Abstract] [PDF]
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[Read E-letter] Effect of propofol on cough reflex
Amar Karmarkar, Ashish Rajkumar   (2 September 2005)

Effect of propofol on cough reflex 2 September 2005
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Amar Karmarkar,
anaesthetist
South Manchester University Hospital,
Ashish Rajkumar

Send letter to journal:
Re: Effect of propofol on cough reflex

Editor, We read with interest the article by Guglielminotti and colleagues (1). This research proves that propofol has an advantage in maintaining the cough reflex in low concentrations and thus preventing aspiration. We all have witnessed the superiority of propofol among the anaesthetic agents,in our clinical practice, over the period of years.

Although this study is a good retrospective reassurance, yet anaesthetist should not be mislead and underestimate the importance of close observation of the patient in recovery. Studies have shown that there is a high degree of inter-patient variation in the concentration of propofol that suppresses the gag response in 50% of the patients Cp50gag (2). Silent aspiration is known to occur in normal patients in spite of being alert (3).

Meticulous observation and close vigilance is must to prevent aspiration in the recovery period, even if the patient has regained the cough reflex.

A. Karmarkar A. Rajkumar. South Manchester University Hospital. E-mail: acarrom@yahoo.co.uk

(1) Guglielminotti J, Rackelboom T, Tesniere A, Panhard X, Mentre F, Bonay M,Mantz J, Desmonts JM. Assessment of cough reflex after propofol anaesthesia for colonoscopy .Br J Anaesth 2005 ; 95:406-9

(2) Kazama T, Takeuchi K, Ikeda K, Ikeda T, Kikura M, Lida T, Suzuki S, Hanai H,Sato S. Optimal propofol plasma concentration during upper gastrointestinal endoscopy in young ,middle aged and elderly patients .Anaesthesiology 2000 ;93:662-9]

(3) Tanaka A, Isono S, Ishikawa T, Nishino T. Laryngeal reflex before and after placement of airway interventions : endotracheal tube and laryngeal mask airway.Anaesthesiology 2005 ; 102:20-5

Conflict of Interest:

None declared