Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial

Ghodraty, Mohammad Reza; Hasani, V A; Bagheri-Aghdam, Amirhossein; Zamani, Mohammad; Pournajafian, Alireza; Rokhtabnak, Faranak; Kholdebarin, Alireza; Nader, Nader D.

doi:10.1016/j.jclinane.2015.09.001

Cited by 11 publications

(13 citation statements)

References 27 publications

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“…During the procedure, the use of suctions should be reduced and if available, a closed system with a filter should be used ( 8 , 9 ). Medications such as remifentanil infusion may be used to reduce coughing and thus decrease the risk of contamination ( 10 ). Cuffed non-fenestrated tracheostomy tubes are most preferred.…”

Section: Discussionmentioning

confidence: 99%

Emergency Tracheostomy in Two Airway Trauma Patients Suspected of COVID-19: A Case Report

et al. 2020

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: Coronavirus disease 2019, known as COVID-19, was first identified in Wuhan, China, in December 2019 and became a pandemic on Mar 11, according to the World Health Organization report. In the epidemic of COVID-19, many patients admitted to hospitals for other reasons may be silent carriers of COVID-19 and have the risk of infecting medical personnel. Thus, meticulous personal protection measures should be considered in suspicious patients, especially when close contact with the patient’s airway is anticipated. We introduce two airway trauma patients suspected of COVID-19 who required emergency tracheostomy. Patient one was a 29-year-old man who suffered facial trauma following a car accident. A chest CT scan showed peripheral ground-glass opacities suggestive for COVID-19. The second patient was a young elevator mechanic who experienced maxillofacial trauma after an elevator crash. The methods of anesthesia and airway protection and safety precautions are described.

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Section: Discussionmentioning

confidence: 99%

Emergency Tracheostomy in Two Airway Trauma Patients Suspected of COVID-19: A Case Report

et al. 2020

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“…1 Acute hemodynamic changes may lead to severe complications, such as hypertension, tachycardia, myocardial ischaemia and cardiac arrhythmia. 2,11 Recently, many methods and drugs, such as deep extubation and intravenous administration of remifentanil, lidocaine or dexmedetomidine, [4][5][6] have been applied to attenuate cough response. However, these methods and drugs can cause respiratory depression, awakening delay and other side effects.…”

Section: Discussionmentioning

confidence: 99%

“…Tanaka et al reported that its incidence varies from 30% to 70% after tracheal intubation. 3 Various methods and drugs have been applied to moderate cough response and POST, [4][5][6] however, these interventions may lead to other complications, such as respiratory depression or delays in postoperative awakening.…”

Section: Introductionmentioning

confidence: 99%

<p>Trans-Cricothyroid Membrane Injection of Local Anesthesia Attenuates Cough Response and Postoperative Sore Throat to the Nasotracheal Tube</p>

Huang¹,

Wang²,

Peng³

et al. 2020

TCRM

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Objective: This study aims to investigate the effects of trans-cricothyroid membrane injection of local anesthesia on cough response and postoperative sore throat to the nasotracheal tube. Methods: Patients who require general anesthesia with nasotracheal tube for oral and maxillofacial surgery were randomised divided into groups L and C. The patients in group L received trans-cricothyroid membrane injection of 2% lidocaine (3 mL) before anesthesia. Meanwhile, the same volume of 0.9% saline was administered to group C. The incidences of cough response, mean arterial pressure (MAP) and heart rate (HR) were recorded during emergency from general anesthesia. Postoperative sore throat (POST) was assessed at 1, 6, 12 and 24 h after surgery. Results: The data of 60 patients in group L and 61 in group C were included in this study. The incidence of cough was lower in group L than in group C, ie, 41.7% vs 67.2% upon extubation (P=0.006) and 20.0% vs 41.0% at five minutes after extubation (P=0.018). MAP and HR in group L were significantly lower than in group C during emergency from general anesthesia (P<0.05). POST incidence was significantly reduced in group L at 1 and 6 h after surgery, ie, 35.0% vs 55.7% at 1 h after surgery (P=0.029) and 20.0% vs 37.7% at 6 h after surgery (P=0.044). Conclusion: Trans-cricothyroid membrane injection of local anesthesia is a simple and effective method to attenuate the incidence of cough response during emergency from general anesthesia. This technique can reduce the incidence of POST after surgery.

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“…Cough grading was based on a modified 4-point Minogue scale: grade 1, no cough; grade 2 (mild), coughing once or twice; grade 3 (moderate), fewer than 4 non-sustained coughs lasting 1–2 s each or overall coughing lasting less than 5 s; grade 4 (severe), at least 4 coughs lasting at least 2 s, or overall coughing duration more than 5 s [ 8 ]. Patients with grades 3 and 4 were categorized as “moderate to severe.” The patients’ levels of sedation were assessed by the Ramsay sedation scale (RSS): 1, the patient is anxious and restless or agitated, or both; 2, the patient is cooperative, tranquil, and oriented; 3, the patient responds to commands only; 4, the patient exhibits a brisk response to loud auditory stimuli or a light glabellar tap; 5, the patient exhibits a sluggish response to a loud auditory stimulus or a light glabellar tap; 6, the patient exhibits no response [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

Dexmedetomidine versus midazolam on cough and recovery quality after partial and total laryngectomy – a randomized controlled trial

Zhu

Lü

et al. 2020

BMC Anesthesiol

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Background During emergence from anesthesia after partial and total laryngectomy, excessive airway reflex and systemic hypertension may lead to subcutaneous emphysema, hemorrhage or pneumothorax. Methods American Society of Anesthesiologist physical status III and IV male adults undergoing elective laryngectomy were recruited and randomly allocated to receive either dexmedetomidine (group D) or midazolam (group M). The primary outcome was incidence and severity of cough. Pulse oximetry results (SpO2), heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were also recorded. The visual analog scale and the Ramsay sedation scale were recorded at the points of wakefulness and departure from the post-anesthesia care unit (PACU). Rescue analgesia consumption, the time of spontaneous breath recovery, duration of the PACU stay, and the incidence of adverse effects were also recorded. Results The prevalence of no coughing was significantly higher in group D than in group M at the points of wakefulness and departure. HR, SBP, and DBP were significantly lower in group D compared with group M, and SpO2 was significantly higher in group D than in group M at the moment of laryngectomy. Pain scores were lower in group D than in group M. The Ramsay score at the point of wakefulness was higher in group D than in group M. There was no difference in time to spontaneous breathing recovery, duration of the PACU stay, and incidence of adverse effects. Conclusions Compared with midazolam, dexmedetomidine is an effective alternative to attenuate coughing and hemodynamic changes with a low incidence of adverse events during emergence from anesthesia after partial and total laryngectomy. Trial registration NCT03918889, registered at clinicaltrials.gov, date of registration: March 28, 2019.

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Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial

Cited by 11 publications

References 27 publications

Emergency Tracheostomy in Two Airway Trauma Patients Suspected of COVID-19: A Case Report

Emergency Tracheostomy in Two Airway Trauma Patients Suspected of COVID-19: A Case Report

<p>Trans-Cricothyroid Membrane Injection of Local Anesthesia Attenuates Cough Response and Postoperative Sore Throat to the Nasotracheal Tube</p>

Dexmedetomidine versus midazolam on cough and recovery quality after partial and total laryngectomy – a randomized controlled trial

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