Effects of age on effect-site concentration of remifentanil for suppressing anesthetic emergence cough in male patients undergoing laparoscopic cholecystectomy

Abstract

BackgroundRemifentanil infusion during emergence lowers cough. Effect-site concentration (Ce) of remifentanil using target-controlled infusion (TCI) has been evaluated in previous studies. Recent studies revealed the existence of sex-related differences in remifentanil Ce in young and elderly patients. Thus, there was the need to re-evaluate the effect of age in single sex. We investigated the remifentanil Ce for suppressing emergence cough in young and elderly male patients and evaluated the age-related differences.Patients and methodsIn total, 25 young (ages between 20 and 50 years) and 24 elderly (ages between 65 and 75 years) male patients undergoing laparoscopic cholecystectomy were enrolled. Anesthesia was implemented with remifentanil using TCI and sevoflurane. The remifentanil Ce for suppressing emergence cough was estimated for each group using Dixon’s up-and-down method and isotonic regression method with a bootstrapping approach.ResultsThe remifentanil Ce for suppressing emergence cough in 50% (EC50) and 95% (EC95) of the patients was comparable between the young and elderly patients. Isotonic regression demonstrated that the EC50 (83% confidence interval [CI]) of remifentanil was 2.56 (2.39−2.75) ng/mL in the young patients and 2.15 (1.92−2.5) ng/mL in the elderly patients. The EC95 (95% CI) of remifentanil was 3.33 (2.94−3.46) ng/mL in the young patients and 3.41 (3.18−3.48) ng/mL in the elderly patients. Dixon’s up-and-down method also demonstrated that the EC50 was comparable between the two groups (2.69±0.32 ng/mL vs 2.39±0.38 ng/mL, P=0.132).ConclusionThe remifentanil Ce for suppressing emergence cough following extubation during general anesthesia was comparable between young and elderly male patients. It indicates that age-related differences in remifentanil requirement for suppressing emergence cough did not exist in male sex.

Influence of (ATP)-Binding Cassette Transporter Subfamily B Member 1 (ABCB1) Gene Polymorphism on the Efficacy of Remifentanil

“…We found no differences in sex, age, BMI, smoking, or and drinking status among the 3 different groups of ABCB1 rs1045642 genotypes. This is similar to the results of studies conducted by other scholars, which also showed that patient sex, age, BMI, smoking, and drinking have no influence on the pharmacodynamics of Remifentanil [15,16]. Hence, it is believed that the sex, age, BMI, smoking, and drinking in this study did not affect the efficacy of Remifentanil, and its dose does not need to be adjusted in different ABCB1 rs1045642 genotype groups according to the sex age, BMI, smoking, and drinking status of the patients.…”

The Impact of Age on Propofol Requirement for Inducing Loss of Consciousness in Elderly Surgical Patients

“…After adjustment for these factors, age was still an independent factor. From the perspective of the increased sensitivity of the elderly to anesthetics, our results do not conflict with previous studies ( Akhtar, 2018 ; Kim et al, 2018 ; Sahinovic et al, 2018 ; You et al, 2019 ). However, unlike previous research paradigms, we focused on elderly surgical population which aged over 65 years, and tried to eliminate the interference caused by concomitant medication, comorbidities and renal insufficiency.…”

Predicting the optimal concentration of remifentanil for skull pin fixation with hemodynamic and analgesia nociception index monitoring

“…On the other hand, Lee et al showed that both the Ce of propofol at 2.9 ± 0.7 mcg/ml (to keep BIS levels between 40 and 50), and the Ce of remifentanil were higher than our results during skull pin fixation, it might be due to age/gender-related differences in the Ce of propofol/remifentanil based on our majority of older female patients 24 , 32 . However, age might not affect the Ce of remifentanil during surgery 33 . Further studies are needed for checking effects of age and gender to Ce of propofol/remifentanil.…”