The Impact of Head Elevation on Preventing Emergence Cough during Endotracheal Extubation in Male Patients

Abstract

Background : Emergence cough during endotracheal extubation can cause complications. This cough occurs when the endotracheal tube deviates from the airway anatomy, applying pressure to the airway's mucosal wall. Head elevation may help align the airway with the tube's position. This study aims to examine the effect of using a pillow for head elevation on the prevalence and severity of emergence cough in male patients. _x000D_ <br>_x000D_ <br>Material/Methods : A total of 71 male patients undergoing laparoscopic cholecystectomy were randomly divided into two groups: the head elevation group (n=35) and the control group (n=36). The head elevation group maintained a neck flexion angle of 35º using a pillow, while the control group remained in a neutral position following anesthetic induction. Cough severity was evaluated before, during, and after extubation using a 4-point scale, where grades 2 and 3 indicated coughing, with grade 3 signifying severe cough. _x000D_ <br>_x000D_ <br>Results : Patient’s characteristics and intraoperative data were comparable. The incidences of cough and severe cough did not differ significantly between the two groups. However, the severity of cough before extubation was significantly lower in the head elevation group compared to the control group (cough scale: 0/5/8/23 in the control group vs 1/2/17/15 in the head elevation group, P=0.039). Time to extubation, respiratory complications, nausea and vomiting, overall and throat pain, and the number of patients receiving the fentanyl as rescue were similar. _x000D_ <br>_x000D_ <br>Conclusions : Using a pillow to elevate the head effectively reduced the severity of cough before endotracheal extubation during anesthesia emergence in male patients. However, it did not significantly decrease the incidence of cough. These findings underscore the potential benefits of head elevation in reducing the discomfort associated with emergence cough. _x000D_ <br>_x000D_ <br>_x000D_ <br>Keywords : emergence cough, head elevation, male, remifentanil_x000D_ <br>_x000D_ <br>Abbreviation : PACU (postanesthesia care unit), HR (heart rate), MAP (mean arterial pressure)