Comparison of dexmedetomidine, lidocaine, magnesium sulfate, and remifentanil in cough suppression during endotracheal extubation: A double-blind, randomized clinical trial

Abstract

Background: This study was undertaken to compare the effects of several drugs on attenuation of stimulatory responses and cough suppression at the end of endotracheal extubation under general anesthesia. Patients and Methods: This trial was conducted on 120 patients who were candidates for general anesthesia in Arak, Iran. The patients were randomly assigned into four groups. All groups received the study drugs 10 min prior to the end of surgery in the following manner: group 1, 0.5 μg/kg intravenous (IV) dexmedetomidine; group 2, 1.5 mg/kg IV lidocaine; group 3, 1 μg/kg IV remifentanil; and group 4, 30 mg/kg IV magnesium sulfate 50%. Laryngospasm, the presence of cough, mean arterial pressure, heart rate (HR), arterial oxygen saturation, and sedation were assessed and recorded. Results: No significant difference was observed in the number of coughs (P = .740) among the study groups. Although the dexmedetomidine group showed more sedation, the lowest increase in HR (P = .001) was observed in lidocaine and dexmedetomidine groups, respectively. The lowest and highest HR was observed in lidocaine and magnesium sulfate groups, respectively. The patients did not have laryngospasm during the assessment. In addition, dexmedetomidine had the highest Ramsay score (P = .019). Conclusion: There was no difference in the amount of laryngospasm and cough in the groups, and due to the lack of no serious complication requiring treatment, the study drugs can be recommended to be used for attenuating and suppressing stimulatory responses during endotracheal extubation.

Keywords

• cough
• dexmedetomidine
• general anesthesia
• laryngospasm
• lidocaine
• magnesium sulfate
• remifentanil