Comparison of alfentanil and sufentanil on extubation-related cough following suspension laryngoscopy surgery: a randomized controlled trial
Introduction This study aimed to compare the effects of alfentanil and sufentanil on cough response during tracheal extubation in patients undergoing suspension laryngoscopy surgery. Methods In this prospective, randomized controlled trial, 80 patients (ASA I–II) scheduled for elective suspension laryngoscopy were enrolled. Patients were randomly allocated to receive either alfentanil (Group A, n = 42; The induction dose for general anesthesia is 21 μg/kg, and maintenance 0.7–1.4 μg·kg−1·min−1) or sufentanil (Group S, n = 38; The induction dose for general anesthesia is 0.3 μg/kg, and maintenance 0.01–0.02 μg·kg−1·min−1), both combined with propofol 2–4 μg·mL−1 target-controlled infusion. The primary outcome was the incidence of cough, including moderate-to-severe cough within 5 min after tracheal extubation. Secondary outcomes included cough during induction, hemodynamic variables, extubation time, recovery scores, postoperative pain, and adverse events. Results The incidence of cough within 5 min after tracheal extubation was significantly higher in Group A than in Group S (69.0% [29/42] vs. 44.7% [17/38]; OR 2.76, 95%CI 1.08–7.00; p = 0.03), whereas the incidence of moderate-to-severe cough did not differ between groups (p > 0.05). During induction, cough occurred less frequently in Group A (11.9% [5/42] vs. 31.6% [12/38]; OR 0.29, 95%CI 0.10–0.89; p = 0.03). Heart rate and mean arterial pressure were lower in Group A at specific intraoperative time points (p < 0.05). Extubation time, Aldrete scores, and postoperative pain scores were comparable between groups (p > 0.05). No opioid-related adverse events were observed. Conclusion In suspension laryngoscopy surgery, alfentanil is associated with a lower incidence of cough during induction but a higher incidence of cough during extubation compared with sufentanil. There was no statistically significant difference in the incidence of moderate-to-severe cough between alfentanil and sufentanil.