Metoprolol for the prevention of bucking during orotracheal extubation

In a recent study, it was shown that metoprolol significantly decreased the risk of bucking during extubation in patients who underwent general anesthesia when compared to the placebo. This study’s findings were published in the Brazilian journal of anesthesiology (Elsevier).

This was a double-blind, placebo-controlled randomized trial that included 207 patients, comprising both males and females aged between 18 and 80 years, with an American Society of Anesthesiologists (ASA) physical status I–III. These patients were randomly allocated into two groups: one group received intravenous metoprolol 5 mg IV (n=102) while the other group received a placebo (n=105) post-surgery. The primary endpoint of the study was to assess the percentage of patients who exhibited bucking as a result of endotracheal tube stimulation of the tracheal mucosa during extubation. Secondary outcomes evaluated included coughing, laryngospasm, bronchospasm, Heart Rate (HR) levels, and Mean Arterial Pressure (MAP).

At the end of the study, the incidence of bucking was significantly lower in patients who were received metoprolol (43.1% vs. 64.8%). In the metoprolol group, 6 (5.9%) patients experienced moderate/severe coughing, while 33 (31.4%) in the placebo group reported the same.

The above results demonstrated that in patients undergoing general anesthesia, metoprolol was found to significantly lower the risk of bucking during extubation when compared with the placebo.