Patients rated American Society of Anesthesiologists class I or II of either sex, aged 18 to 60 years, who were scheduled for elective abdominal surgery with
general anesthesia were randomly and equally assigned to 3 groups using a computer-generated table of random numbers. The patients received equivalent doses of
fentanyl 2 μg/kg,
sufentanil 0.2 μg/kg, or
remifentanil 2 μg/kg via IV push. Vital signs (systolic blood pressure [SBP], heart rate [HR], and oxygen saturation via pulse oximetry [SpO2]) and the occurrence and severity of
cough were recorded for 2 minutes after
drug administration by an anesthesiologist who was blinded to the
drug treatment. The severity of
cough was graded as none (0), mild (1-2), moderate (3-5), or severe (>5).
RESULTS: A total of 315 Chinese patients (197 women, 118 men; mean [SD] age, 37.9 [10.4] years) were approached for enrollment and assigned to 3 groups of 105 patients each; all patients completed the study protocol. The 3 treatment groups were similar in terms of demographic characteristics and type of abdominal surgery. The incidence of
cough was significantly greater in the
remifentanil group (57 [54.3%] patients) than in the
fentanyl group (35 [33.3%]; P < 0.01) or the
sufentanil group (32 [30.5%]; P < 0.01). The severity of
cough was significantly greater in the
remifentanil group (severe, moderate, mild, none: 24, 7, 26, 48) than in the
fentanyl (7, 9, 19, 70; P < 0.01) or
sufentanil group (4, 2, 26, 73; P < 0.01). In all 3 groups, when the patients coughed, significant increases were observed in their SBP (128 [12]-139 [16] mm Hg; P < 0.01) and HR (74 [10]-87 [16] beats/min; P < 0.01). Within 2 minutes after
drug administration, 62 patients (59%) in the
remifentanil group experienced
hypoxemia (SpO2 <90%) necessitating manually assisted mask ventilation, while no patients experienced
hypoxemia in the
fentanyl or
sufentanil group. Three patients (2.9%) in the
remifentanil group experienced
muscle rigidity and deterioration of SBP, HR, and SpO2. No other adverse events were recorded. Cunclusion:
Remifentanil was associated with a significantly greater incidence and severity of
cough than equivalent doses of
fentanyl or
sufentanil.
Fentanyl and
sufentanil appeared comparable in these Chinese patients undergoing abdominal surgery.