A Randomized Comparison of Remifentanil Target-Controlled Infusion Versus Dexmedetomidine Single-Dose Administration

Abstract

Remifentanil target-controlled infusion and dexmedetomidine single-dose administration are known to reduce airway response and hemodynamic stimulation during anesthetic recovery. We compared the effects of 2 drugs on the prevention of cough during emergence. We enrolled 70 female patients aged 20-60 years with American Society of Anesthesiologists (ASA) I-II who underwent general anesthesia for elective thyroidectomy. The patients were randomly assigned to remifentanil (group R) or dexmedetomidine (group D). Anesthesia was maintained with sevoflurane and effect-site target-controlled infusion of remifentanil. In group D, remifentanil was discontinued, and dexmedetomidine 0.5 μg/kg was given 10 minutes before the end of surgery. In group R, remifentanil target-controlled infusion at an effective-site concentration of 2.0 ng/mL was maintained during emergence until extubation. The cough grade, hemodynamic values, respiration, and other recovery profiles were evaluated during the periextubation period. The proportion of patients with no cough or just a single cough during extubation was significantly higher in group R than in group D (96.8% vs. 55.9%). The change of mean arterial pressure and heart rate were not significantly different during extubation in both groups. Respiratory rate and the incidence of residual sedation after extubation were lower in group R. There were no desaturation events and no differences in time to extubation or duration of postanesthesia care unit stay in both groups. Remifentanil target-controlled infusion reduces emergence cough from general anesthesia more effectively than single-dose dexmedetomidine. However, a single-dose of dexmedetomidine has the effect with respect to respiratory and hemodynamic stability during emergence.

Effect of topical ropivacaine on the response to endotracheal tube during emergence from general anesthesia: a prospective randomized double-blind controlled study

“…Opioids may bring ahout possible respiratory depression, sedative effects, and PONV. Dexmedetomidine suppresses the airway reflex during extubation when the pantients without restoration of consciousness [ 17 , 18 ].…”

Effects of intravenous infusion of lidocaine and dexmedetomidine on inhibiting cough during the tracheal extubation period after thyroid surgery

“…A previous study has shown that a peripheral alpha-2 receptor may be involved in cough inhibition [22]. In addition, a previous study showed that the sedative characteristics of dexmedetomidine can suppress the sensitivity of tracheal stimulation, which then results in cough inhibition [23]. However, several studies have shown that a dexmedetomidine infusion, at a rate of 0.4 μg/kg/h during the operation period, did not inhibit cough [24,25].…”

“…However, several studies have shown that a dexmedetomidine infusion, at a rate of 0.4 μg/kg/h during the operation period, did not inhibit cough [24,25]. Park et al [23]. compared the effect of a single dose of 0.5μg/kg dexmedetomidine with remifentanil by the use of a target-controlled infusion in reducing cough during anesthetic emergence.…”

Effect of dexmedetomidine on recovery profile of patients undergoing anterior cervical discectomy and fusion

“…[ 18 ] Effectiveness of dexmedetomidine to reduce the incidence and severity of coughing at extubation has been shown with variable success by the use of bolus doses in the range from 0.4 to 0.8 μg/kg prior to extubation as compared to placebo[ 9 15 19 ] or fentanyl[ 10 ] or remifentanil. [ 20 ] Reasons for decreased coughing in the dexmedetomidine group have not been clearly defined in any study but have been postulated to the concomitant sedative and analgesic nature of drug. However, continuous infusion of dexmedetomidine has failed to show its superiority over placebo in reducing the incidence of coughing after nasal surgery.…”