Desflurane and the sensitivity of upper airway reflexes

Sixty consecutive patients who were given an anesthetic, not needing tracheal intubation, received desflurane as part of the anesthetic technique to assess the incidence of upper airway irritation. A variety of induction agents and artificial airways were used. The incidence of upper airway irritation was recorded. Eight patients coughed at induction. Five of these were related to insertion of a laryngeal mask and probably represent light anesthesia. One was unrelated to instrumentation, another caused by a partially obstructed airway and the final one occurred in a child with an upper respiratory tract infection. Six episodes of coughing and hiccoughs occurred after the end of anesthesia. Four were related to removal of an airway. Five episodes of coughing occurred in the ten smokers, confirming the importance of this as a risk factor. Six patients who coughed were given no premedication or were anesthetized before it could take effect. Coughing occurs during general anesthesia, but it is caused by many factors. In adults, using desflurane it does not appear to be a significant risk factor.