Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia

Abstract

BackgroundCoughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation.MethodsIn total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 µg/kg/hr (Group S1) or 0.3 µg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery.ResultsGroups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences.ConclusionsA sufentanil infusion (0.2-0.3 µg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV.

Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial

“…5 Reported cases highlight the role of vigorous coughing in potentially favouring airway rupture related to mechanical tracheal intubation when a double-lumen tube (DLT) is used. 6,7 Many pharmacological and non-pharmacological techniques have been used to reduce coughing at emergence in patients with single-lumen endotracheal tubes (ETTs) in place, [8][9][10][11][12] but these methods have not been applied to the situation of DLTs used chiefly in thoracic surgery. When using a DLT, the overall chosen diameter is normally greater than that of an ETT, and the DLT is in contact with a greater area of the tracheobronchial tree, increasing the potential for cough stimuli.…”

Emergence from anaesthesia: Have we got it all smoothened out?

“…Cough during emergence is seen when desflurane is used; short acting opioids such as alfentanil and sufentanil have been found to suppress the cough when used as a bolus dose at the end of surgery. [56] With a pleasant smell, sevoflurane has been a very useful agent for induction in paediatric population but emergence agitation is more when compared to other agents. [78] Various drugs have been used to reduce this incidence including propofol, α2-adrenoceptor agonists, midazolam and ketamine.…”

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations

“…These studies compared intravenous PCA morphine versus oxycodone,27 fentanyl versus oxycodone,28–30 and brief infusions of remifentanil31 or sufentanil32 before extubation. There is insufficient evidence to specifically recommend one opioid over another.…”