Smooth emergence in men undergoing nasal surgery: the effect site concentration of remifentanil for preventing cough after sevoflurane-balanced anaesthesia.

Abstract

BACKGROUND:

Suppression of cough during emergence after nasal surgery is practical to avoid bleeding from the surgical site. Previously recommended effect-site concentration of remifentanil for preventing cough during emergence is restricted to female patients undergoing thyroid surgery, so we evaluated effective effect-site concentration of remifentanil for preventing cough during emergence for men undergoing nasal surgery.

METHODS:

Twenty-four American Society of Anesthesiologists (ASA) physical status I or II, between the ages of 18 and 60 years old, non-smoker male patients undergoing nasal surgery were enrolled in this study. The effective effect-site concentration for 50% of patients (EC(50) ) and and that for 95% of patients (EC(95) ) of remifentanil for preventing cough were determined by Dixon's up-and-down method and by isotonic regression method with a bootstrapping approach. Haemodynamic variables were compared in patients with cough and without cough during emergence.

RESULTS:

The EC(50) of remifentanil for preventing cough during emergence by Dixon's method was 2.17 ng/ml [standard deviation (SD) 0.38]. The estimated EC(50) and EC(95) of remifentanil using isotonic regression model with a bootstrapping approach were 2.35 ng/ml [95% confidence interval (CI) 1.89-2.66] and 2.94 ng/ml (95% CI 2.83-2.97), respectively. Mean arterial pressure and heart rate were significantly higher in patients with cough during emergence. Three out of 13 patients that received more than 2.5 ng/ml of remifentanil experienced a brief episode of bradypnea.

CONCLUSIONS:

The EC(95) of remifentanil for preventing cough in men after nasal surgery is 2.94 ng/ml. Remifentanil target-controlled infusion with established effect-site concentration could suppress cough in men during emergence from sevoflurane anaesthesia after nasal surgery, though reversible respiratory depression might arise at high effect-site concentration of remifentanil.

• Authors: E M Choi, W-K Park, S-H Choi, S Soh, J-R Lee
• Journal: Acta anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 56 Issue 4 Pg. 498-503 (Apr 2012) ISSN: 1399-6576 [Electronic] England
• PMID: 22220983 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2012 The Authors Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

Chemical References

• Anesthetics, Inhalation
• Methyl Ethers
• Piperidines
• Sevoflurane
• Remifentanil

Topics

• Adolescent
• Adult
• Anesthesia, Inhalation
• Anesthetics, Inhalation (adverse effects)
• Blood Pressure (drug effects)
• Cough (prevention & control)
• Heart Rate (drug effects)
• Humans
• Male
• Methyl Ethers (adverse effects)
• Middle Aged
• Nose (surgery)
• Piperidines (therapeutic use)
• Remifentanil
• Sevoflurane