Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia

Background: The effects of total intravenous anaesthesia (TIVA) and balancedanaesthesia (BAL) on coughing during emergence from the generalanaesthesia have not yet been compared. Methods: Fifty patients, aged 18–60 yr, undergoing elective lumbardisk surgery were randomly allocated to undergo TIVA (propofol–remifentanil)or BAL (fentanyl–nitrous oxide–sevoflurane). Extubationwas performed in the knee–elbow position, documented onvideo, and subsequently evaluated by blinded examiners. Results: There was no difference between TIVA and BAL patients with respectto patient characteristics, proportion of smokers, surgicaltime, or time of emergence. The median number of coughs wassignificantly lower in the TIVA group (1, range 0–9) thanin the BAL group (4, range 0–20, P = 0.007). Mean maximalheart rate and mean maximal arterial pressure measured duringemergence were also significantly lower in the TIVA group (P= 0.009 and P = 0.006, respectively). Conclusions: During emergence from anaesthesia in the knee–elbow position,TIVA is associated with significantly less coughing and reducedhaemodynamic response when compared with BAL.