A Comparison of Laryngospasm in "No Touch" and "Head Down Deep Extubation": A Randomized Clinical Trials

Niyoosha Yoosefi; Fatemeh Hajimohammadi; Arash Jafarieh; Hamed Abdollahi; Afshar Etemadi  Ale Agha; Mehrdad Behzadi; Nader Ali Nazemian; Mina Abdolahi; Mohammad Gholizadeh; Abolghasem Yousefi

doi:10.18502/aacc.v9i5.13956

Niyoosha Yoosefi Faculty of Medicine, University of British Columbia, Canada.
Fatemeh Hajimohammadi Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Arash Jafarieh Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Hamed Abdollahi Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Afshar Etemadi Ale Agha Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Mehrdad Behzadi Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Nader Ali Nazemian Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Mina Abdolahi Department of Clinical Nutrition, Amir-Alam Hospital Complexe, Tehran University of Medical Sciences, Tehran, Iran.
Mohammad Gholizadeh Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abolghasem Yousefi Department of Anesthesiology, Amir-Alam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v9i5.13956

Keywords: Laryngospasm; Incidence; No touch; Head down deep extubation; Tonsillectomy; Adenotonsillectomy; Children

Abstract

Background: Tonsillectomy and adenotonsillectomy are simple surgical procedures that can cause laryngospasm as complications which blocks airflow causing serious issues. The laryngospasm incidence decreases in patients undergoing deep extubation. Present study aimed to compare laryngospasm in innovative method of head down deep extubation with No Touch method.

Methods: Forty-two patients were enrolled in the study in (23 females and 19 males) between the ages of 5 up to 15 who were referred for tonsillectomy or adenotonsillectomy. The patients were divided into two randomized No Touch (n=21) and head down deep extubation (n=21) intervention groups according to permuted block randomization. All patients received standard general anesthesia. The first group received the no-touch extubation and the second group received head down deep extubation method. The duration of surgery, Time interval between the injection of reverse drugs and the return of spontaneous breathing (TRDRSB), time interval between anesthesia drug withdrawal and extubation (TIDWE), SPO2, incidence of laryngospasm, and cough were recorded and graded according to their severity at 0, 5, 10, 15 minutes and 2 hours after extubation, respectfully.

Results: The age, weight, gender and duration of surgery, TRDRSB was not statistically different between the two groups but TIDWE showed a significant difference between groups (P<0.001). The SPO2 levels in 0, 5, 10, 15 minutes, and 2 hours after surgery were not significantly different between the “no touch” and “head down deep extubation” groups as well as the severity of coughing and laryngospasm. However, the rate of laryngospasm and cough in "No touch" group was higher than " head down deep extubation " group.

Conclusion: HDDE is an innovative technique that it seems in comparison to No Touch method can reduce the incidence of laryngospasm. However, further comprehensive trials are needed to confirm these findings.