Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial☠☠â˜

•Fiberoptic bronchoscopy can result in cough, laryngospasm, and/or bronchospasm.•Propofol and ketamine suppress N-methyl-d-aspartate receptors and thus can suppress coughing.•Ketamine and propofol did not decrease post-FOB cough during emergence.•Ketamine, greater than propofol, decreased emergence agitation.•Ketamine lengthened recovery time in children undergoing FOB.

Study ObjectiveTo determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia.DesignRandomized, double-blind, placebo-controlled trial.SettingOperating room, postoperative recovery area.PatientsSixty-eight children aged 1 to 8 years old undergoing elective diagnostic FOBL.InterventionsAfter discontinuation of anesthetics at the end of FOBL, patients were randomly divided into 3 groups: in group K, children were administered 0.5 mg/kg of ketamine; in group P, 0.5 mg/kg of propofol; and in group C, 0.1 mL/kg of normal saline.MeasurementsAnesthesia time, procedure time, emergence time, and recovery time were recorded. Coughing and delirium scores were recorded as the patient fully emerged from anesthesia (time 0) and 5, 10, 15, and 20 minutes later.Main ResultsThe percentage of children with moderate or severe cough during emergence was similar in all groups. Mean delirium scores at emergence (T0) were significantly lower in group K than those in group P and in group C (P = .0001 and P = .02). Mean delirium score at 5 minutes in group K (6 [5-10]) was significantly lower than that of group C (P = .02) and similar to that of group P. The recovery time of group K was significantly longer than that of group C and group P (P = .01 and P = .03, respectively).ConclusionsKetamine or propofol given at the end of sevoflurane-remifentanil general anesthesia in children undergoing FOBL did not decrease cough more than normal saline during the emergence period. Ketamine and propofol, compared to normal saline, had a beneficial effect on decreasing the incidence of emergence delirium. Ketamine lengthened recovery time.