Targeting smooth emergence: the effect site concentration of remifentanil for preventing cough during emergence during propofol–remifentanil anaesthesia for thyroid surgery

Lee, B.; Lee, J.-R.; Na, Sungwon

doi:10.1093/bja/aep090

Cited by 84 publications

(97 citation statements)

References 17 publications

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“…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. Dexmedetomidine has analgesic and sedative effects without respiratory depression, and intraoperative infusions of dexmedetomidine have previously been shown to allow for a smooth emergence from anesthesia by attenuating agitation, cough, and hemodynamic changes in children.…”

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%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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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“…Remifentanil infusions have been extensively described as a method of providing conscious sedation for awake fibreoptic intubation in the spontaneously breathing patient [115][116][117][118][119] and evidence is emerging to support a similar strategy during emergence and extubation [120][121][122][123][124][125]. Several factors influence the dose of remifentanil necessary to prevent coughing at extubation, and relate to patient characteristics, surgical procedure and the anaesthetic technique.…”

Section: General Principlesmentioning

confidence: 99%

Difficult Airway Society Guidelines for the management of tracheal extubation

Mitchell¹,

Dravid²,

Patel³

et al. 2012

Anaesthesia

400

139

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SummaryTracheal extubation is a high‐risk phase of anaesthesia. The majority of problems that occur during extubation and emergence are of a minor nature, but a small and significant number may result in injury or death. The need for a strategy incorporating extubation is mentioned in several international airway management guidelines, but the subject is not discussed in detail, and the emphasis has been on extubation of the patient with a difficult airway. The Difficult Airway Society has developed guidelines for the safe management of tracheal extubation in adult peri‐operative practice. The guidelines discuss the problems arising during extubation and recovery and promote a strategic, stepwise approach to extubation. They emphasise the importance of planning and preparation, and include practical techniques for use in clinical practice and recommendations for post‐extubation care.

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“…response was followed by a negative response according to the up-and-down method [10]. The Dixon's up and down method needs at least six pairs for statistical analysis [10,11]. The study was continued until seven pairs of successful-failed MACBAR had occurred.…”

Section: Methodsmentioning

confidence: 99%

Effect of midazolam pretreatment on desflurane MACBAR at an effect-site concentration of remifentanil 1.0 ng/ml

No¹,

Han²,

Kim³

2015

Anesth Pain Med

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Targeting smooth emergence: the effect site concentration of remifentanil for preventing cough during emergence during propofol–remifentanil anaesthesia for thyroid surgery

Abstract: We found that the EC(95) of effect site concentration of remifentanil to suppress coughing at emergence from anaesthesia was 2.14 ng ml(-1). Maintaining an established Ce of remifentanil is a reliable method of abolishing cough and thereby targeting smooth emergence from anaesthesia.

Cited by 84 publications

References 17 publications

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

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

Difficult Airway Society Guidelines for the management of tracheal extubation

Effect of midazolam pretreatment on desflurane MACBAR at an effect-site concentration of remifentanil 1.0 ng/ml

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