Coughing is a normal protective airway reflex that occurs commonly during emergence from general anesthesia. However, emergence coughing can lead to significant morbidity and sequela in certain patient populations and procedures. Current popular drug choices for emergence coughing prevention include fentanyl, remifentanil, and lidocaine. Dexmedetomidine is a highly specific and potent alpha-2 adrenergic agonist that provides sedative, anxiolytic, analgesic, and anti-shivering effects, but notably, dexmedetomidine has significant antitussive properties. Studies have shown that dexmedetomidine can significantly suppress emergence coughing with little to no effect on ventilation and with little to no delay in extubation time (Kim et al., 2021; Wang et al., 20233). Dexmedetomidine, in comparison to opioids and lidocaine, may even be one of the more superior options for emergence cough prevention when administered in the perioperative period (Tung et al., 2020). CRNAs should consider adding dexmedetomidine to their repertoire as an adjunct or even as their primary intervention for preventing emergence coughing.
Learning Objectives:
Compare dexmedetomidine to opioids and local anesthetics for effectiveness in cough prevention.
Identify dosing and administration strategies of dexmedetomidine for emergence cough prevention.
