Target controlled remifentanil infusion for smooth laryngeal mask airway removal during emergence from desflurane–remifentanil anesthesia

Abstract

Administration of remifentanil can be a reliable method for preventing airway reflex responses during emergence. We therefore investigated the effect of maintaining target controlled infusion (TCI) of remifentanil for smooth cLMA removal during emergence from desflurane-remifentanil anaesthesia. Forty-one patients undergoing uretero-renoscopy under general anesthesia with desflurane and at 1-4 ng/ml TCI remifentanil infusion were randomly assigned to a control group (n = 20) or a remifentanil group (n = 21). At the end of the surgery, desflurane and remifentanil infusion were stopped in group C and remifentanil was maintained at the effect-site concentration of 1.5 ng/ml TCI in group R. When LMA removal was accomplished without coughing, teeth clenching, gross purposeful movements, breath holding, laryngospasm, and desaturation to SpO(2) less than 90%, removal was regarded as smooth (successful). The emergence and recovery profiles were also evaluated. The incidence and number of complications (coughing, teeth clenching, gross purposeful movements, breath holding, laryngospasm, desaturation to SpO(2) <90%) were significantly higher in the control group than in the remifentanil group (p = 0.002). Maintaining effect-site TCI of remifentanil at 1.5 ng/ml during emergence from anaesthesia enabled smooth removal of cLMA without any delay in recovery time.