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High peak inspiratory pressure may be associated with intraoperative coughing during neurosurgery under general anesthesia without neuromuscular blockade: a retrospective study

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Authors

Oh, Hyongmin; Sohn, Jin You; Ma, Seoyoung; Choi, Seungeun; Kim, Yoon Jung; Lee, Hyung-Chul; Lee, Chang-Hyun; Kim, Chi Heon; Chung, Chun Kee; Park, Hee-Pyoung

Issue Date
2023-04-14
Publisher
BMC
Citation
BMC Anesthesiology, 23(1):123
Keywords
Intraoperative coughingNeurosurgeryPeak inspiratory pressure
Abstract
Background
The endotracheal cuff pressure depends on the airway pressure during positive-pressure ventilation. A high endotracheal cuff pressure may be related to intraoperative coughing, which can be detrimental during neurosurgery. We investigated the incidence of intraoperative coughing and its association with peak inspiratory pressure (PIP) during neurosurgery under general anesthesia without neuromuscular blockade.
Methods
This retrospective study divided 1656 neurosurgical patients who underwent total intravenous anesthesia without additional neuromuscular blockade after tracheal intubation into high (PIP > 21.6 cmH2O, n = 318) and low (PIP ≤ 21.6 cmH2O, n = 1338) PIP groups. After propensity score matching, 206 patients were selected in each group. Demographic, preoperative, surgical, and anesthetic data were collected retrospectively from electronic medical records and continuous ventilator, infusion pump, and bispectral index data from a data registry.
Results
Intraoperative coughing occurred in 30 (1.8%) patients, including 9 (0.5%) during the main surgical procedure. Intraoperative coughing was more frequent in the high PIP group than in the low PIP group before (14/318 [4.4%] vs. 16/1338 [1.2%], P < 0.001) and after (13/206 [6.3%] vs. 1/206 [0.5%], P = 0.003) propensity score matching. In multivariable logistic regression analysis after propensity score matching, a high PIP (odds ratio [95% confidence interval] 14.22 [1.81-111.73], P = 0.012), tidal volume divided by predicted body weight (mL/kg, 1.36 [1.09–1.69], P = 0.006), and surgical duration (min, 1.01 [1.00–1.01], P = 0.025) predicted intraoperative coughing.
Conclusion
The incidence of intraoperative coughing was 1.8% in neurosurgical patients undergoing general anesthesia without neuromuscular blockade and might be associated with a high PIP.
ISSN
1471-2253
Language
English
URI
https://hdl.handle.net/10371/192398
DOI
https://doi.org/10.1186/s12871-023-02080-6
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