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