The effectiveness of a subhypnotic dose of propofol in preventing laryngospasm following tonsillectomy and adenoidectomy in children: A prospective, cohort study .

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Date

2020-06

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Addis Abeba University

Abstract

Background : Laryngospasm is defined as the sustained closure of the vocal cords, well-known problem typically occurring immediately following tracheal extubation. This blockage can lead to hypoxemia, negative-pressure pulmonary edema, pulmonary aspiration, and cardiac arrest. Incidence of laryngospasm is as high as 25% in patients undergoing tonsillectomy and adenoidectomy. Propofol is an intravenous drug use for the induction of general anesthesia and for moderate to deep sedation, which is also known to strongly suppress airway responses. At a lower concentration than the anesthetic dose, propofol may help to reduce or prevent laryngospasm after extubation in pediatric patients Objective: To determine the effectiveness of propofol to prevent laryngospasm during adenoid and tonsillectomy cases under general anesthesia. Methods: In this institutional based prospective cohort study 66 pediatric patients age up to 9 years were included. It was conducted from December 2019-March 2020 at Tikur Anbessa specialized hospital, Yekatit 12 hospital and Menilke hospital, pediatric patients who scheduled to undergo elective tonsillectomy with or without adenoidectomy under standard general anesthesia who fulfilled the inclusion criteria were included in the study. The data was recorded as group P if anesthesia providers gave suphypnotic dose of propofol(0.5mg/kg) one minute before extubation as well the data were recorded as group C if the anesthesia provider just extubate without giving propofol. Normality of the data was checked using Shapiro-Wilk test and analyzed using student t test for normal distributed data and chi-square test for categorical data. Non- parametric data was analyzed using Mann –Whitney U test with 95% CI and p- value less than 0.05 is considered as statistically significant. Result: Comparison of data from Propfol group and Control group using chi square showed that occurrence of laryngospasm was significantly lower in P group then group C (9.1 Vs. 42.4) with p-value less than 0.05. With no significant difference in the severity of laryngospasm and vital sign changes between groups. Conclusions and Recommendation: Subhypnotic dose of propofol (0.5 mgÆkg)1) decreases the occurrence of laryngospasm upon tracheal extubation in children undergoing tonsillectomy with or with out adenoidectomy. We recommend anesthetists to use 0.5mg/kg of propofol one minute before extubation to prevent postextubation laryngospasm. And we also recommend further randomized control trial in order to avoid bias.

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Keywords

Subhypnotic dose,laryngospasm ,tonsillectomy ,adenoidectomy

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