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

Autor:	de Queiroz MN; Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil; TSA, Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil. Electronic address: murilo.queiroz@escs.edu.br., Mendonça FT; Hospital de Base do Distrito Federal, Brasília, DF, Brazil; TSA, Sociedade Brasileira de Anestesiologia, Rio de Janeiro, RJ, Brazil., de Matos MV; Hospital de Base do Distrito Federal, Brasília, DF, Brazil., Lino RS; Hospital de Base do Distrito Federal, Brasília, DF, Brazil., de Carvalho LSF; Hospital de Base do Distrito Federal, Brasília, DF, Brazil; Escola Superior de Ciências da Saúde, Brasília, DF, Brazil; Clarity Healthcare Intelligence, Jundiaí, SP, Brazil.
Jazyk:	angličtina
Zdroj:	Brazilian journal of anesthesiology (Elsevier) [Braz J Anesthesiol] 2024 Mar-Apr; Vol. 74 (2), pp. 744455. Date of Electronic Publication: 2023 Aug 02.
DOI:	10.1016/j.bjane.2023.07.012
Abstrakt:	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 tracheal 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. Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. (Copyright © 2023. Published by Elsevier España S.L.U.)
Databáze:	MEDLINE
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