Journal of Anesthesiology and Pain

Aims and Background: Airway hyperactivity is one of the most important complications of tracheal extubation. This study was designed to compare the efficacy of intravenous acetaminophen as an alternative to remifentanil on airway response to tracheal tubes during and at the end of anesthesia in functional endoscopic sinus surgery.

Methods and materials: This study was conducted as a double blind clinical trial on 70 patients 20 to 60 years old, candidate for endoscopic sinus surgery, in Rasoul-Akram hospital. They were randomly allocated into two groups: the Paracetamol (n=35) and the remifentanil (n=35) groups. Remifentanil infusion with a dose of 0 /1μg/kg/min was administered for both groups during anesthesia . Since the beginning of inserting the nose tampon until extubation, remifentanil infusion (0/1 μg/kg/min ) was continued in group I, and in group II in the last 20 minutes of surgery , remifentanil infusion was discontinued and intravenous injection of acetaminophen was begun . Incidece of Cough, Arterial blood pressure, and heart rate were recorded.

Findings : There was no significant difference in the incidence rate of cough during extubation between the two groups (P=0.7). M ean arterial pressure (MAP) v ariation, was significantly lower in the remifentanil group (P<0.001). Variations in heart rate were similar in both groups ( P=0.74).

Conclusions: Using intravenous acetaminophen has the same effect as remifentanil in controling airway reflexes after endoscopic sinus surgery as well as reducing symptoms such as restlessness and changes in heart rate.