Abstract
During emergence from general anesthesia, coughing caused by the endotracheal tube frequently occurs and is associated with various adverse complications. In patients undergoing endovascular neurointervention, achieving smooth emergence from general anesthesia without coughing is emphasized since coughing is associated with intracranial hypertension. Therefore, the up-and-down method was introduced to determine the effective effect-site concentration (Ce) of remifentanil to prevent coughing in 50% and 95% (EC50 and EC95) of patients during emergence from sevoflurane anesthesia for endovascular neurointervention. A total of 43 participants, American Society of Anesthesiologists class I or II participants, aged from 20 to 70 years who were undergoing endovascular neurointervention through transfemoral catheter for cerebrovascular disease were enrolled. Using the up-and-down method with isotonic regression, the EC50 and EC95 of remifentanil to prevent coughing during emergence from sevoflurane anesthesia were determined. We also investigated differences of hemodynamic and recovery profiles between the cough suppression group and the cough group. In total, 38 of 43 patients were included for estimation of EC50 and EC95. The EC50 and EC95 of remifentanil to prevent coughing were 1.42 ng/mL (95% confidence interval [CI], 1.28–1.56 ng/mL) and 1.70 ng/mL (95% CI, 1.67–2.60 ng/mL), respectively. There was comparable emergence and recovery data between the cough suppression group (n = 22) and the cough group (n = 16). However, the Ce of remifentanil and total dose of remifentanil were significantly higher in the cough suppression group (P = 0.002 and P = 0.004, respectively). Target-controlled infusion of remifentanil at 1.70 ng/mL could effectively prevent extubation-related coughing in 95% of neurointervention patients, which could ensure smooth emergence.
Highlights
While emerging from general anesthesia, coughing induced by the endotracheal tube (ETT) frequently occurs and is associated with various adverse complications including intracranial hypertension [1], increased intraocular pressure [2], hypertension, and tachycardia [3]
The purpose of this study was to find the effective Ce of remifentanil to prevent coughing in 50% and 95% (EC50 and EC95) of patients during emergence from sevoflurane anesthesia after endovascular neurointervention
The main finding of our study is that the emergence in 50% (EC50) and EC95 of remifentanil to prevent coughing during emergence from sevoflurane anesthesia are 1.42 ng/mL and Duration of postanesthetic care unit (PACU) stay RR
Summary
While emerging from general anesthesia, coughing induced by the endotracheal tube (ETT) frequently occurs and is associated with various adverse complications including intracranial hypertension [1], increased intraocular pressure [2], hypertension, and tachycardia [3]. There have been efforts to prevent coughing while emerging from anesthesia, and prevention is emphasized in specific clinical situations. Opioids are a commonly used therapeutic option to prevent and resolve coughing in patients with respiratory disease as well as with airway irritation [4,5]. Previous studies demonstrated the antitussive effect of remifentanil for emergence from anesthesia under various settings and reported effective and safe suppression of coughing by target-controlled infusion (TCI) of remifentanil [6,7,8]. Various factors including patient age, sex, procedures, and anesthetic agents affect the effect-site concentration (Ce) of remifentanil [4,6,9,10,11]. Remifentanil administration to prevent coughing during emergence should be customized to the specific settings [4]
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