Journal of Anesthesiology and Pain

Aim and Background:

Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these response, so we examined the effects of maintaining a remifentanil infusion in the recovery room, on recovery profiles such as coughing and cardiovascular responses after general anesthesia.

Methods and Materials:

In a prospective, double-blinded, randomized trial, we enrolled 60 adult patients undergoing nasal surgery with remifentanil-based anesthesia. During the emergence phase, the infusion rate of remifentanil was reduced to 0.02 micro/kg/min in treatment group 1 and to 0.05 micro/kg/min in treatment group 2, whereas in the control group remifentail was discontinued and placebo was started instead.

Findings: 

During emergence, both of the treatment groups had a significantly lower incidence and severity of coughing and slower heart rate. The mean systolic blood pressure (MAP) in the treatment group 2 was significantly lower compared with the other groups, but the awakening or extubation time was prolonged in this group, whereas time interval to awakening and tracheal extubation was similar between the control group and treatment group 1.

Conclusions:

Maintaining a low-dose remifentanil infusion during emergence did not prolong awakening but reduced heart rate and the incidence and severity of coughing due to the endotracheal tube, whereas high-dose remifentanil infusion reduced the hemodynamic changes and coughing associated with tracheal extubation while significantly delaying the extubation time.