Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.07.012
Brazilian Journal of Anesthesiology
Original Investigation

Metoprolol for prevention of bucking at orotracheal extubation: a double-blind, placebo-controlled randomised trial

Metoprolol para prevenção de bucking na extubação orotraqueal: um ensaio randomizado duplo-cego, controlado por placebo

Murilo Neves de Queiroz, Fabrício Tavares Mendonça, Maurício Vargas de Matos, Rafael Santos Lino, Luiz Sérgio Fernandes de Carvalho

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Abstract

Background

Respiratory responses to extubation can cause serious postoperative complications. Beta-blockers, such as metoprolol, can interfere with the cough pathway. However, whether metoprolol can effectively control respiratory reflexes during extubation remains unclear. The objective of this study is to evaluate the efficacy of intravenous metoprolol in attenuating respiratory responses to tracheal extubation.

Methods

Randomized, double-blinded, placebo-controlled trial. Setting: Tertiary referral center located in Brasília, Brazil. Recruitment: June 2021 to December 2021. Sample: 222 patients of both sexes with an American Society of Anesthesiologists (ASA) physical status I–III aged 18–80 years. Patients were randomly assigned to receive intravenous metoprolol 5 mg IV or placebo at the end of surgery. The primary outcome was the proportion of patients who developed bucking secondary to endotracheal tube stimulation of the racheal mucosa during extubation. Secondary outcomes included coughing, bronchospasm, laryngospasm, Mean Blood Pressure (MAP), and Heart Rate (HR) levels.

Results

Two hundred and seven participants were included in the final analysis: 102 in the metoprolol group and 105 in the placebo group. Patients who received metoprolol had a significantly lower risk of bucking (43.1% vs. 64.8%, Relative Risk [RR = 0.66], 95% Confidence Interval [95% CI 0.51–0.87], p = 0.003). In the metoprolol group, 6 (5.9%) patients had moderate/severe coughing compared with 33 (31.4%) in the placebo group (RR = 0.19; 95% CI 0.08–0.43, p < 0.001).

Conclusion

Metoprolol reduced the risk of bucking at extubation in patients undergoing general anesthesia compared to placebo.

Keywords

Airway extubation Cough Hypertension Metoprolol Tachycardia and hypertension

Resumo

Introdução

As respostas respiratórias à extubação podem causar complicações pós-operatórias graves. Os betabloqueadores, como o metoprolol, podem interferir na via da tosse. No entanto, ainda não está claro se o metoprolol pode controlar eficazmente os reflexos respiratórios durante a extubação. O objetivo deste estudo é avaliar a eficácia do metoprolol intravenoso na atenuação das respostas respiratórias à extubação traqueal.

Métodos

Ensaio randomizado, duplo-cego e controlado por placebo. Local: Centro de referência terciário localizado em Brasília, Brasil. Recrutamento: junho de 2021 a dezembro de 2021. Amostra: 222 pacientes de ambos os sexos com estado físico I–III da American Society of Anesthesiologists (ASA) com idade entre 18–80 anos. Os pacientes foram randomizados para receber metoprolol intravenoso 5 mg IV ou placebo no final da cirurgia. O desfecho primário foi a proporção de pacientes que desenvolveram bucking secundário à estimulação do tubo endotraqueal na mucosa traqueal durante a extubação. Os desfechos secundários incluíram tosse, broncoespasmo, laringoespasmo, níveis de pressão arterial média (PAM) e frequência cardíaca (FC).

Resultados

Duzentos e sete participantes foram incluídos na análise final: 102 no grupo metoprolol e 105 no grupo placebo. Os pacientes que receberam metoprolol tiveram um risco significativamente menor de bucking (43,1% vs. 64,8%, risco relativo [RR = 0,66], intervalo de confiança de 95% [IC 95% 0,51–0,87], p = 0,003). No grupo do metoprolol, 6 (5,9%) pacientes apresentaram tosse moderada/grave em comparação com 33 (31,4%) no grupo placebo (RR = 0,19; IC 95% 0,08–0,43, p < 0,001).

Conclusão

O metoprolol reduziu o risco de bucking na extubação em pacientes submetidos à anestesia geral em comparação ao placebo.

Palavras-chave

Extubação das vias aéreas; Tosse; Hipertensão; Metoprolol; Taquicardia e hipertensão

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Submitted date:
01/28/2023

Accepted date:
07/25/2023

6516ed76a9539510d056f2c6 rba Articles
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