Kim Ha Yeon, Kim Jong Yeop, Ahn Soo Hwan, Lee Sook Young, Park Hee Yeon, Kwak Hyun Jeong
Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon Department of Anesthesiology and Pain Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon, Republic of Korea.
Medicine (Baltimore). 2018 Jun;97(26):e11258. doi: 10.1097/MD.0000000000011258.
Smooth emergence or cough prevention is a clinically important concern in patients undergoing laryngomicroscopic surgery (LMS). The purpose of this study was to estimate the effective concentration of remifentanil in 95% of patients (EC95) for the prevention of emergence cough after LMS under propofol anesthesia using the biased coin design (BCD) up-down method.A total of 40 adult patients scheduled to undergo elective LMS were enrolled. Anesthesia induction and maintenance were performed with target-controlled infusion of propofol and remifentanil. Effective effect-site concentration (Ce) of remifentanil in 95% of patients for preventing emergence cough was estimated using a BCD method (starting from 1 ng/mL with a step size of 0.4 ng/mL). Hemodynamic and recovery profiles were observed after anesthesia.According to the study protocol, 20 patients were allocated to receive remifentanil Ce of 3.0 ng/mL, and 20 patients were assigned to receive lower concentrations of remifentanil, from 1.0 to 2.6 ng/mL. Based on isotonic regression with a bootstrapping method, EC95 (95% CI) of remifentanil Ce for the prevention of emergence cough from LMS was found to be 2.92 ng/mL (2.72-2.97 ng/mL). Compared with patients receiving lower concentrations of remifentanil, the incidence of hypoventilation before extubation and extubation time were significantly higher in those receiving remifentanil Ce of 3.0 ng/mL. However, hypoventilation incidence after extubation and staying time in the recovery room were comparable between the 2 groups.Using a BCD method, the EC95 of remifentanil Ce for the prevention of emergence cough was estimated to be 2.92 ng/mL (95% CI: 2.72-2.97 ng/mL) after LMS under propofol anesthesia.
平稳苏醒或预防咳嗽是接受喉显微手术（LMS）患者的一个临床重要关注点。本研究的目的是使用偏倚硬币设计（BCD）上下法，估计在丙泊酚麻醉下接受LMS的患者中95%预防苏醒期咳嗽所需瑞芬太尼的有效浓度（EC95）。共纳入40例计划接受择期LMS的成年患者。采用丙泊酚和瑞芬太尼靶控输注进行麻醉诱导和维持。使用BCD方法（从1 ng/mL开始，步长为0.4 ng/mL）估计95%患者预防苏醒期咳嗽所需瑞芬太尼的有效效应室浓度（Ce）。麻醉后观察血流动力学和恢复情况。根据研究方案，20例患者被分配接受3.0 ng/mL的瑞芬太尼Ce，20例患者被分配接受1.0至2.6 ng/mL的较低浓度瑞芬太尼。基于自抽样方法的等渗回归，发现预防LMS苏醒期咳嗽的瑞芬太尼Ce的EC95（95%CI）为2.92 ng/mL（2.72 - 2.97 ng/mL）。与接受较低浓度瑞芬太尼的患者相比，接受3.0 ng/mL瑞芬太尼Ce的患者拔管前低通气发生率和拔管时间显著更高。然而，两组患者拔管后低通气发生率和在恢复室停留时间相当。使用BCD方法，在丙泊酚麻醉下LMS后，预防苏醒期咳嗽的瑞芬太尼Ce的EC95估计为2.92 ng/mL（95%CI：2.72 - 2.97 ng/mL）。
