Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial.

OBJECTIVE

To examine the severity of cough and straining at the time of emergence from anesthesia.

DESIGN

Double-blind randomized, placebo-controlled study.

SETTING

University-affiliated hospital.

PATIENTS

Sixty-two American Society of Anesthesiologists 2 patients undergoing craniotomy and excision of supratentorial cerebral tumors.

INTERVENTION

Intravenous infusion of remifentanil (REM) at 0.05 μg/kg/min or normal saline (NS) upon termination of the surgical procedure.

MEASUREMENTS

Heart rate (HR) and mean arterial pressure (MAP) along with the frequency and severity of cough response (Modified Minogue Scale) to the endotracheal tube were recorded at different time points. The frequency of cough and straining was analyzed with χ(2) tests. HRs and MAP were analyzed by repeated-measures analysis of variance between REM and NS groups.

MAIN RESULTS

There was no case of significant cough in the REM group, and all of the patients in the NS group developed some extent of cough varying from mild retching to severe coughing episodes (P < .001). Both the HR and MAPs were consistently lower in the REM group compared to the NS group.

CONCLUSION

Infusion of REM at the end of craniotomy procedures results in significant reduction of the frequency and severity of coughing and straining. Compared to placebo, REM moderates increases in MAP upon emergence from general anesthesia until the time of extubation.