The Effect of Low-Dose Remifentanil on Responses to the Endotracheal Tube During Emergence from General Anesthesia

Aouad, Marie T.; Al-Alami, Achir A.; Nasr, Viviane G.; Souki, Fouad G.; Zbeidy, Reine; Siddik-Sayyid, Sahar M.

doi:10.1213/ane.0b013e31819b03d8

Cited by 101 publications

(81 citation statements)

References 7 publications

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“…Anatomical and physiological changes contribute to a situation that can be more challenging than intubation for the anesthesiologist. A severe extubation response can significantly increase BP and HR (Aouad et al, 2009), potentially leading to postoperative hemorrhage, intracranial hypertension and/or intraocular hypertension (Leech et al, 1974;Saghaei et al, 2005;Irwin, 2006).…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine via trans-cricothyroid membrane injection inhibits the extubation response in patients undergoing surgery for maxillary and mandibular fractures

Gao

et al. 2014

Genet. Mol. Res.

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ABSTRACT. Extubation response can lead to cardiovascular and respiratory complications. Here, we aimed to evaluate the effect of ropivacaine injected via the trans-cricothyroid membrane on the extubation response. This prospective, double-blind, randomized study included 70 patients classified as American Society of Anesthesiologists status I-II, who required general anesthesia with nasotracheal intubation for maxillary and mandibular fracture surgery; patients were divided into the ropivacaine (20 mg) and dicaine (20 mg) groups. Both groups were injected via the trans-cricothyroid membrane. Mean arterial pressure (MAP), heart rate (HR), and incidence and severity of cough were recorded during intubation and extubation. During intubation, there was no significant intergroup difference in MAP or HR and no occurrence of coughing (P > 0.05). During extubation, MAP and HR were significantly lower in the ropivacaine group than the dicaine group (P < 0.05). The proportion of patients with no reports of cough was significantly higher in the ropivacaine group than in dicaine group (P < 0.05). The number of patients with grade 1 or 2 cough was significantly higher in the dicaine group than that in the ropivacaine group (P < 0.05). There was no significant intergroup difference in the rate of postoperative complications (P > 0.05). These results suggest that the administration of ropivacaine via trans-cricothyroid membrane injection can effectively inhibit the extubation response.

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Section: Discussionmentioning

confidence: 99%

Ropivacaine via trans-cricothyroid membrane injection inhibits the extubation response in patients undergoing surgery for maxillary and mandibular fractures

Gao

et al. 2014

Genet. Mol. Res.

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“…1,2 Maintenance of a low-dose remifentanil infusion has been reported to decrease the incidence of coughing and induce a smooth emergence from general anesthesia. 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.…”

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confidence: 99%

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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“…2 Other newer exciting strategies described in recent literature include the use of dexmedetomidine, the use of low-dose remifentanil to ameliorate endotracheal tubeinduced airway irritation during emergence, 4 and the use of the Boussignac CPAP system immediately following extubation to improve oxygenation. 5 The OSA patient poses special challenges to the anesthesiologist.…”

Section: Replymentioning

confidence: 99%

Airway management in obstructive sleep apnea: local solutions

Beriault

2010

Can J Anesth/J Can Anesth

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The Effect of Low-Dose Remifentanil on Responses to the Endotracheal Tube During Emergence from General Anesthesia

Abstract: Low-dose remifentanil during emergence did not prolong wake-up but reduced the incidence and severity of coughing from the endotracheal tube.

Cited by 101 publications

References 7 publications

Ropivacaine via trans-cricothyroid membrane injection inhibits the extubation response in patients undergoing surgery for maxillary and mandibular fractures

Ropivacaine via trans-cricothyroid membrane injection inhibits the extubation response in patients undergoing surgery for maxillary and mandibular fractures

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

Airway management in obstructive sleep apnea: local solutions

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