Pharmacologic methods to minimise coughing during extubation in the era of COVID-19

Abstract

Background/aim: Given the current severe acute respiratory syndrome coronavirus 2 pandemic, coughing at the time of extubation is at risk of creating aerosolisation. This may place health care workers at risk of nosocomial infection during the perioperative period. This study aims to summarise the current pharmacologic methods to minimise cough at the time of extubation, and to determine whether some strategies could be more beneficial than others.

Methods: This is a summary of systematic reviews. A comprehensive search through MEDLINE was performed. Thirty-three publications were screened for eligibility. Only the manuscripts discussing pharmacologic methods to minimise coughing on extubation were included in this review.

Findings: Many pharmacological agents have been proposed to decrease the incidence of cough at the time of extubation. Of these, intravenous administration of dexmedetomidine (relative risk 0.4; 95% CI: 0.4-0.5) or remifentanil (RR 0.4; 95% CI: 0.4-0.5) seems to have the largest effect to reduce cough on extubation.

Conclusion: The available data in the current literature is sparse. Yet, dexmedetomidine and remifentanil seem to be the most efficient agents to decrease the incidence of emergence coughing.

Keywords: Aerosol-generating procedures; Airway management; Anaesthesia; COVID-19; Tracheal intubation.

Figure 1

Flow diagram of systematic review selection

Figure 2

Pharmacologic interventions to reduce cough during extubation. Data are relative risks (RR) of coughing on extubation and 95% confidence intervals (CI), compared with placebo. Intracuff lidocaine = Tung et al. Intracuff lidocaine (2) = Peng et al