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

• Published in: Journal of clinical anesthesia 2016-09, Vol.33, p.514-520
• Main Authors: Ghodraty, Mohammad Reza, Hasani, Valiollah, Bagheri-Aghdam, Amirhossein, Zamani, Mohammad Mahdi, Pournajafian, Alireza, Rokhtabnak, Faranak, Kholdebarin, Alireza, Nader, Nader D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia & Perioperative Care; Anesthesia Recovery Period; Arterial Pressure - drug effects; Blood pressure; Cough - prevention & control; Coughing; Craniotomy; Double-Blind Method; Edema; Emergence; Extubation; Female; Heart Rate - drug effects; Hemodynamic; Hemodynamics - drug effects; Humans; Hypertension; Informed consent; Infusions, Intravenous; Intubation, Intratracheal - adverse effects; Male; Medical personnel; Middle Aged; Narcotics; Pain Medicine; Patients; Piperidines - administration & dosage; Piperidines - therapeutic use; Postoperative Complications - drug therapy; Prospective Studies; Remifentanil; Straining; Surgery; Ventilation
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2015.09.001

Abstract Objective To examine the severity of cough and straining at the time of emergence from anesthesia. Design Double-blind randomized, placebo-controlled study. Setting University-affiliated hospital. Patients Sixty-two American Society of Anesthesiologists 2 patients undergoing craniotomy and excision of supratentorial cerebral tumors. Intervention Intravenous infusion of remifentanil (REM) at 0.05 μg/kg/min or normal saline (NS) upon termination of the surgical procedure. Measurements Heart rate (HR) and mean arterial pressure (MAP) along with the frequency and severity of cough response (Modified Minogue Scale) to the endotracheal tube were recorded at different time points. The frequency of cough and straining was analyzed with χ2 tests. HRs and MAP were analyzed by repeated-measures analysis of variance between REM and NS groups. Main Results There was no case of significant cough in the REM group, and all of the patients in the NS group developed some extent of cough varying from mild retching to severe coughing episodes ( P < .001). Both the HR and MAPs were consistently lower in the REM group compared to the NS group. Conclusion Infusion of REM at the end of craniotomy procedures results in significant reduction of the frequency and severity of coughing and straining. Compared to placebo, REM moderates increases in MAP upon emergence from general anesthesia until the time of extubation.