Abstract
BackgroundPreventing emergence cough after nasal surgery is critical. Emergence cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction. In the present study, we compared the effect-site concentration (Ce) of remifentanil to prevent emergence cough after propofol anesthesia for nasal surgery when remifentanil was or was not combined with dexmedetomidine.MethodsForty-seven patients with propofol-remifentanil anesthesia for nasal surgery were randomly assigned to a dexmedetomidine group (Group D, n = 23) or a saline group (Group S, n = 24). Group D and Group S were infused with dexmedetomidine (0.5 μg/kg) and saline, respectively, for 10 min before the completion of surgery. A predetermined Ce of remifentanil was infused until extubation. Remifentanil Ce to prevent cough in 50 and 95% of patients (EC50 and EC95) was estimated using modified Dixon’s up-and-down method and isotonic regression. Hemodynamic and recovery parameters were recorded.ResultsThe EC50 of remifentanil Ce was significantly lower in Group D than in Group S (2.15 ± 0.40 ng/mL vs. 2.66 ± 0.36 ng/mL, p = 0.023). The EC95 (95% CI) of remifentanil Ce was also significantly lower in Group D [2.75 (2.67–2.78) ng/mL] than in Group S [3.16 (3.06–3.18) ng/mL]. Emergence and recovery variables did not differ between the two groups.ConclusionThe remifentanil EC50 to prevent cough after propofol-remifentanil anesthesia was significantly lower (approximately 19%) when a combination of remifentanil and 0.5 μg/kg dexmedetomidine was used than when remifentanil infusion alone was used in patients undergoing nasal surgery. Therefore, the Ce of remifentanil may be adjusted to prevent emergence cough when used in combination with dexmedetomidine.Trial registrationClinicalTrials.gov (NCT03622502, August 9, 2018).
Highlights
IntroductionEmergence cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction
Preventing emergence cough after nasal surgery is critical
The Ce of remifentanil may be adjusted to prevent emergence cough when used in combination with dexmedetomidine
Summary
Emergence cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction. We compared the effect-site concentration (Ce) of remifentanil to prevent emergence cough after propofol anesthesia for nasal surgery when remifentanil was or was not combined with dexmedetomidine. Emergence cough after general anesthesia leads to serious adverse effects including surgical site bleeding, wound disruption, hemodynamic instability, and increased intracranial and intraocular pressure [1]. The prevention of cough in nasal surgery patients is especially important because cough can provoke immediate postoperative bleeding, which leads to upper airway obstruction [2]. An increasing dose of remifentanil may effectively prevent cough, this drug increases the incidences of adverse effects including respiratory depression, nausea and vomiting, or delayed emergence [3, 7]. To decrease remifentanil’s Ce and its side effects when administered alone, co-administration of other adjuvant drugs may prove useful
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