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The effect of remifentanil on cough suppression after endoscopic sinus surgery: a randomized study
Author(s) -
CHEN J.,
LI W.,
WANG D.,
HU X.
Publication year - 2010
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2010.02303.x
Subject(s) - medicine , remifentanil , anesthesia , propofol , endoscopic sinus surgery , incidence (geometry) , surgery , general anaesthesia , physics , optics
Background: Excessive coughing may increase the risk of complications after sinus surgery. We hypothesized that remifentanil would decrease the incidence and severity of coughing after endoscopic sinus surgery with propofol and remifentanil anaesthesia. Methods: Ninety patients scheduled for endoscopic sinus surgery were randomly assigned into three groups. Propofol was stopped at the completion of the surgical procedure. The remifentanil infusion was adjusted to an effect‐site concentration of 1.5, 2.0 or 2.5 ng/ml, 10 min before the anticipated end of surgery, in each of the three groups (RF 1.5 , RF 2.0 and RF 2.5 ) and continued until after extubation. The incidence and severity of coughing was evaluated on a scale from 0 to 3. Results: The proportion of patients who did not cough was significantly higher in the RF 2.0 (67.5%, 95% CI: 59.1–75.9%) and RF 2.5 (74.2%, 95% CI: 66.4–82.0%) groups than in the RF 1.5 group (35.%, 95% CI: 26.5–43.5%) ( P <0.01). The incidence of grade 2 or 3 coughing was significantly higher in the RF 1.5 group (grade 2: 15.1%, grade 3: 6.7%) than in the RF 2.0 group (grade 2: 5.0%, grade 3: 0%) and the RF 2.5 group (grade 2: 4.2%, grade 3: 0%) ( P <0.05). There was no statistically significant difference in the time to extubation among the three groups. Conclusion: Maintaining anaesthesia with remifentanil to the end of the surgery, until after extubation, can suppress coughing without prolonging the recovery from anaesthesia. This effect is dose dependent and is more pronounced at higher concentrations of remifentanil (2.0 or 2.5 ng/ml).