Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Abstract

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

Effect of Pharmacological Agents Administered for Attenuating the Extubation Response on the Quality of Extubation: A Systematic Review

“…The hemodynamic response was reported as blood pressure (BP) and heart rate (HR) change in all trials but the manner of reporting was different among studies. Nine studies documented a change in systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR [2][3]7,[12][13][14][15][16][17] while 12 studies documented the changes in mean arterial pressure (MAP) and HR only [5][6][18][19][20][21][22][23][24][25][26][27]. Three studies documented changes in MAP in addition to SBP, DBP, and HR [28][29][30].…”

“…Three studies documented changes in MAP in addition to SBP, DBP, and HR [28][29][30]. A saline control group was used in 18 studies [2,[6][7][12][13][14][15][16][17][18][19][21][22][24][25][26][29][30]. In four studies, no placebo was used in the control against the study drug [3,20,[27][28].…”

“…Cough was observed in 13 placebo-controlled studies [2,[13][14][15][16][18][19][21][22][25][26][29][30], and all these studies were included in the meta-analysis. Overall, cough developed in 23.2% of patients in the intervention group and 42.6% in the control group.…”

“…Six studies compared the alpha agonist with the placebo [15,18,[25][26][29][30]. The incidence of cough was significantly reduced with alpha agonists.…”

“…Dexmedetomidine in different doses was compared to saline in seven studies [6][7]15,18,25,[29][30]. The doses used were 0.4 ug/kg [6][7]18], 0.5 ug/kg [15,25,30], 0.75 ug/kg [29], and 0.8 ug/kg [7]. All the authors reported significantly higher sedation in the patient groups who were administered dexmedetomidine.…”