Jeong Soo Lee1, Seung Ho Choi, Young Ran Kang, Yunhee Kim, Yon Hee Shim. 1. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea.
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 statusI-II adults undergoing elective thyroidectomy under sevoflurane anesthesia were recruited and randomly allocated to receive either dexmedetomidine 0.5 μg·kg(-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 μg·kg(-1)) of dexmedetomidine during emergence from sevoflurane-remifentanil 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.
RCT Entities:
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 μg·kg(-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 μg·kg(-1)) of dexmedetomidine during emergence from sevoflurane-remifentanil 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.
Authors: Clyde T Matava; Pete G Kovatsis; Jennifer K Lee; Pilar Castro; Simon Denning; Julie Yu; Raymond Park; Justin L Lockman; Britta Von Ungern-Sternberg; Stefano Sabato; Lisa K Lee; Ihab Ayad; Sam Mireles; David Lardner; Simon Whyte; Judit Szolnoki; Narasimhan Jagannathan; Nicole Thompson; Mary Lyn Stein; Nicholas Dalesio; Robert Greenberg; John McCloskey; James Peyton; Faye Evans; Bishr Haydar; Paul Reynolds; Franklin Chiao; Brad Taicher; Thomas Templeton; Tarun Bhalla; Vidya T Raman; Annery Garcia-Marcinkiewicz; Jorge Gálvez; Jonathan Tan; Mohamed Rehman; Christy Crockett; Patrick Olomu; Peter Szmuk; Chris Glover; Maria Matuszczak; Ignacio Galvez; Agnes Hunyady; David Polaner; Cheryl Gooden; Grace Hsu; Harshad Gumaney; Caroline Pérez-Pradilla; Edgar E Kiss; Mary C Theroux; Jennifer Lau; Saeedah Asaf; Pablo Ingelmo; Thomas Engelhardt; Mónica Hervías; Eric Greenwood; Luv Javia; Nicola Disma; Myron Yaster; John E Fiadjoe Journal: Anesth Analg Date: 2020-07 Impact factor: 5.108