Effect‐site concentration of remifentanil to prevent cough after laryngomicrosurgery

Chang, Chul Ho; Lee, Jong Wha; Choi, Jong Rim; Shim, Yon Hee

doi:10.1002/lary.24199

Cited by 27 publications

(33 citation statements)

References 17 publications

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“…20 Although high-dose remifentanil is highly effective for cough suppression, it may result in undesirable events, such as delayed awakening, increased postoperative nausea and vomiting, and prolonged PACU LOS. 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.…”

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%

“…[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. 8,9 Dexmedetomidine produces sedation while sparing responsiveness to CO 2 , and thus, it has less effect on respiratory depression.…”

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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%

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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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“…5 Reported cases highlight the role of vigorous coughing in potentially favouring airway rupture related to mechanical tracheal intubation when a double-lumen tube (DLT) is used. 6,7 Many pharmacological and non-pharmacological techniques have been used to reduce coughing at emergence in patients with single-lumen endotracheal tubes (ETTs) in place, [8][9][10][11][12] but these methods have not been applied to the situation of DLTs used chiefly in thoracic surgery. When using a DLT, the overall chosen diameter is normally greater than that of an ETT, and the DLT is in contact with a greater area of the tracheobronchial tree, increasing the potential for cough stimuli.…”

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Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial

Tanoubi

Sun

Drolet

et al. 2015

Can J Anesth/J Can Anesth

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Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial Remplacement de la sonde double lumière par une sonde à une seule lumière ou un masque laryngé pour réduire la toux lors du réveil suivant une chirurgie thoracique: une étude randomisée contrôlée en simple aveugle Abstract Background Coughing episodes occur frequently at extubation after thoracic surgery, and this may be due in part to the double-lumen tube (DLT). In this study, the DLT was replaced with either a single-lumen endotracheal tube (ETT) or a laryngeal mask airway (LMA) device or left in place, and the incidence of coughing at emergence was compared between the three groups. Methods Fifty-eight adults scheduled for thoracic surgery with a DLT were included. Exclusion criteria were an anticipated difficult airway, obesity, and contraindication to the use of an LMA ProSeal TM (LMA-P). After surgery but before emergence, patients were randomized to having the DLT (1) removed and replaced by an LMA-P (LMA-P Group), (2) removed and replaced by an ETT (ETT Group), or (3) left in place (DLT Group). The primary outcome was the number of coughing episodes at extubation. Results Among 184 patients screened, 124 did not meet inclusion criteria, and two patients, both in the ETT Group, were excluded after randomization, leaving 20, 18, and 20 patients in the LMA-P, ETT, and DLT Groups, respectively. There were fewer coughing episodes (median [quartiles]) in the LMA-P Group than in the DLT Group (0[0-1] vs 2 [1-3], respectively; P = 0.01). In the DLT Group, 90% of patients coughed at least once. This incidence was not significantly different in the ETT Group (83%; P = 0.222) but was significantly reduced in the LMA-P Group (35%; P \ 0.001). No patient had oxygen desaturation during airway exchange or at extubation. The incidence and severity of hoarseness and sore throat were similar in all groups. Conclusion Coughing at extubation after thoracic surgery can be reduced if the DLT is replaced by an LMA-P before emergence. The number of patients in this trial was too small to evaluate the risks associated with exchanging the airway device. This trial was registered at ClinicalTrials.gov: NCT00925613. RésuméContexte Les épisodes de toux surviennent fréquemment lors de l'extubation après une chirurgie thoracique, et ils pourraient être provoqués en partie par la sonde double This study was performed at the Department of Anesthesiology, Hôpital Maisonneuve Rosemont, a Université de Montréal affiliated centre.

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“…Entrega datos con alta precisión para alcanzar y mantener concentraciones deseadas en sitio efecto, proporcionando una ventaja con respecto a la administración farmacológica de acuerdo con dosis estándar. Dichas concentraciones (según objetivos terapéuticos) han sido reportadas por diversos autores [26][27][28][29][30][31] .…”

Section: Desempeño Del Algoritmo Y Variabilidadunclassified

Design and performance evaluation of the “iTIVA” algorithm for manual infusion of intravenous anesthetics based on effect-site target☆

Ramírez

Calvache

2016

Colombian Journal of Anesthesiology

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Effect‐site concentration of remifentanil to prevent cough after laryngomicrosurgery

Abstract: Maintenance of remifentanil at Ce 1.5 and 2 ng/mL suppressed coughing without serious adverse events during emergence from anesthesia with propofol and remifentanil in patients undergoing laryngomicrosurgery.

Cited by 27 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

Replacing a double-lumen tube with a single-lumen tube or a laryngeal mask airway device to reduce coughing at emergence after thoracic surgery: a randomized controlled single-blind trial

Design and performance evaluation of the “iTIVA” algorithm for manual infusion of intravenous anesthetics based on effect-site target☆

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