ORIGINAL ARTICLE: Optimal effect‐site concentration of remifentanil for preventing cough during emergence from sevoflurane‐remifentanil anaesthesia*

Jun, Na Hyung; Lee, J. W.; Song, Jong Wook; Koh, Jae Chul; Park, W. S.; Shim, Yon Hee

doi:10.1111/j.1365-2044.2010.06450.x

Cited by 46 publications

(52 citation statements)

References 24 publications

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“…12 The incidence of coughing in our study was relatively high (64% in Group D and 91% in Group P, respectively) compared with previous studies (up to 74%, even in a placebo control group) in patients after thyroidectomy under sevoflurane and remifentanil. 4,24,25 The difference might be due to the characteristics of the patients in our study, the intensity of tactile stimuli during emergence from anesthesia, and the investigator's technique during extubation. Furthermore, it might be caused by an overly sensitive evaluation of coughing because we considered small movements of the head at extubation as coughing.…”

Section: Discussionmentioning

confidence: 87%

“…In a previous study, the estimated incidence of cough during emergence from sevoflurane-remifentanil anesthesia with remifentanil TCI 1 ngÁmL -1 was 63%. 4 Assuming that the dexmedetomidine infusion reduces the incidence of cough by 50% and an a of 0.05, 64 patients would be required in each treatment group (assuming a power of 0.80). Anticipating a study drop-out rate of 10%, we included 71 patients per group.…”

Section: Discussionmentioning

confidence: 99%

“…20 Although high-dose remifentanil is highly effective for cough suppression, it may result in undesirable events, such as delayed awakening, increased postoperative nausea and vomiting, and prolonged PACU LOS. 4,5 Remifentanil infusion at 2 ngÁmL -1 via TCI depressed spontaneous respirations 5 and was estimated as an effective concentration (EC 95 ) for preventing cough during emergence from anesthesia. 7 Thus, combination (with dexmedetomidine) therapy might be desirable for preventing cough as an alternate to increasing the concentration of remifentanil.…”

Section: Discussionmentioning

confidence: 99%

“…3 Several studies have shown that the optimal effect-site concentration (Ce) of remifentanil for cough suppression during emergence ranges from 1.5-2.9 lgÁmL -1 . [4][5][6][7] Further increasing the dose of remifentanil can be effective in preventing coughing but may cause respiratory depression, delay emergence from anesthesia, and increase the incidence of postoperative nausea and vomiting. 4,5 Dexmedetomidine is a selective a 2 -adrenoreceptor agonist that has dose-dependent sedative, analgesic, and sympatholytic properties.…”

mentioning

confidence: 99%

“…[4][5][6][7] Further increasing the dose of remifentanil can be effective in preventing coughing but may cause respiratory depression, delay emergence from anesthesia, and increase the incidence of postoperative nausea and vomiting. 4,5 Dexmedetomidine is a selective a 2 -adrenoreceptor agonist that has dose-dependent sedative, analgesic, and sympatholytic properties. 8,9 Dexmedetomidine produces sedation while sparing responsiveness to CO 2 , and thus, it has less effect on respiratory depression.…”

mentioning

confidence: 99%

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Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Lee

Choi

Kang

et al. 2014

Can J Anesth/J Can Anesth

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Purpose Maintenance of a remifentanil infusion during anesthetic emergence has been reported to decrease the incidence of coughing and thereby help to ensure a smooth emergence. It may, however, cause respiratory depression and possibly delay emergence. The purpose of this study was to investigate the effect of a single dose of dexmedetomidine combined with a low-dose remifentanil infusion on cough suppression during emergence from general anesthesia. Methods American Society of Anesthesiologists physical status I-II adults undergoing elective thyroidectomy under sevoflurane anesthesia were recruited and randomly allocated to receive either dexmedetomidine 0.5 lgÁkg -1 iv (Group D, n = 70) or saline (Group S, n = 71), each combined with a low-dose remifentanil infusion ten minutes before the end of surgery. Coughing was assessed using a four-point scale. The respiratory rate (RR), heart rate (HR), and mean arterial pressure were also recorded. Results The incidence of coughing was lower in Group D than in Group S (64% vs 91%, respectively; mean difference 27%; 95% confidence interval [CI] 13 to 41; P \ 0.001). The median cough grade at extubation was also lower in Group D. Mean arterial pressure and HR were elevated in Group S during tracheal extubation but were similar to baseline values in Group D. There was no difference in RR between the two groups throughout the study. A small delay in extubation was observed in Group D (3 minutes longer than Group S; 95% CI 2 to 4; P \ 0.001). Conclusion Compared with an infusion of low-dose remifentanil alone, the addition of a single dose (0.5 lgÁkg -1 ) of dexmedetomidine during emergence from sevofluraneremifentanil anesthesia was effective in attenuating coughing and hemodynamic changes and did not exacerbate respiratory depression after thyroid surgery. This trial was registered at Clinicaltrial.gov, identifier: NCT01774305. RésuméObjectif Il a été rapporté que le maintien d'une perfusion de remifentanil pendant l'émergence anesthésique diminuait This study was presented as a scientific poster at the

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