Fentanyl versus Remifentanil for Cough Suppression and Recovery after Video-Assisted Thoracic Surgery

Abstract

Background: Various methods have been used to reduce postoperative pain after thoracic surgery. However, these methods may affect the patient's respiratory response and delay recovery from anesthesia. We aimed to evaluate the effects of fentanyl and remifentanil during extubation after video-assisted thoracic surgery (VATS). Methods: This study included 45 randomly-selected male patients who underwent VATS for pneumothorax between July 2011 and August 2012. We divided the participants into 3 groups: the F group, which received a bolus injection of 1.0 µg/kg of fentanyl; the R1 group, which received a 0.04 µg/kg/min remifentanil infusion; and the R2 group, which received a 0.08 µg/kg/min remifentanil infusion. Hemodynamics, pain, cough, consciousness level, and nausea were assessed for each group. Results: The number and severity of coughs were lower in the R1 and R2 groups than in the F group, and there were no differences between the R1 and R2 groups. Respiratory depression and loss of consciousness were not observed in any of the patients, and there were no differences in hemodynamics. Conclusion: In comparison with fentanyl, remifentanil did not result in a wide fluctuation of blood pressure and heart rate upon emergence from general anesthesia. Moreover, remifentanil contributed to cough suppression and postoperative pain control. Remifentanil seems to be a safe and effective analgesic after VATS.

Effectiveness of Eutectic Mixture of Local Anesthetics in Preventing Postoperative Sore Throat

“…There is compelling evidence that the judicious application of opioids can significantly suppress the cough response which may reduce the irritation and injury to the airway mucosa from the tracheal tube. 3…”

In Response

“…The group that received fentanyl had more incidence and severity of cough. 4 In addition, Son et al 4 used double-lumen tracheal tubes, which have considerably bigger diameters and may lead to more significant airway irritation than the single-lumen tracheal tubes used in our study. We did mention in the limitations of our study that coughing on extubation may have influenced POST, which could not be avoided entirely.…”

“…The second concern highlighted by Sun and Yang 1 is intraoperative fentanyl use, which causes cough suppression during extubation or in the early recovery period and may therefore impact POST and cough. However, the cough suppression in the study by Son et al 4 cited by Sun and Yang 1 was primarily due to remifentanil. The group that received fentanyl had more incidence and severity of cough.…”

Anesthetic management for inhibiting sympathetic activation in an adolescent patient diagnosed with catecholaminergic polymorphic ventricular tachycardia and undergoing left cardiac sympathetic denervation: A case report

“…22,23 As extubation itself can also be physically stressful, increasing BP and HR, consideration should be given to smooth extubation by preventing airway irritation and cough in addition to pain control for gentle recovery from anesthesia. [29][30][31] Several options have been introduced for this, including deep extubation, exchanging the endotracheal tube to a laryngeal mask airway prior to extubation, and limiting unnecessary stimulation on emergence such as the "No-Touch technique". 30,32,33 Pharmacologic interventions such as intravenous remifentanil, dexmedetomidine, or lidocaine can be added to facilitate these techniques.…”