Department of Anesthesiology and Pain Medicine, Korea University, Ansan Hospital, Kyung-gi-do, Korea.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Int J Med Sci. 2019 Jan 24;16(3):376-383. doi: 10.7150/ijms.30227. eCollection 2019.
Combination of dexmedetomidine and opioid may be an alternative to high-dose opioid in attenuating cough during emergence from anesthesia, while also reducing the adverse effects of high-dose opioid. We tested the hypothesis that a single-dose of dexmedetomidine combined with low-dose remifentanil infusion during emergence would not be inferior to high-dose remifentanil infusion alone in attenuating cough after thyroidectomy. One hundred sixty-nine patients undergoing thyroidectomy were enrolled and randomized in a 1:1 ratio into group DR or group R. Each patient received an infusion of dexmedetomidine (0.5 μg/kg) and low-dose remifentanil infusion of effect-site concentration (Ce) at 1 ng/mL or normal saline and high-dose remifentanil infusion of Ce at 2 ng/mL for 10 min at the end of surgery. Remifentanil was maintained until tracheal extubation. Primary endpoint was the severity of coughing, which was assessed for non-inferiority using a four-point scale at the time of extubation. For comparison of coughing incidence during emergence, coughing grade was also measured at three times: before extubation, at extubation, and after extubation. Time to awakening, hemodynamic and respiratory profile, pain, and postoperative nausea and vomiting were also evaluated for superiority. The 95% confidence intervals for differences in cough grade during tracheal extubation were <0.9, indicating non-inferiority of the single dose of dexmedetomidine combined with low-dose remifentanil infusion. The incidence of coughing was similar in the two groups. Hemodynamic changes during tracheal extubation were attenuated, but emergence from anesthesia was delayed, in group DR. Use of rescue antiemetic was similar in both groups, but the incidence of vomiting was less in group DR. A single-dose of dexmedetomidine (0.5 μg/kg) combined with low-dose remifentanil infusion at 1 ng/mL of Ce during emergence from sevoflurane-remifentanil anesthesia was not inferior to high-dose remifentanil infusion alone at 2 ng/mL of Ce with regard to suppressing cough.
右美托咪定联合阿片类药物可能是一种替代高剂量阿片类药物减轻麻醉苏醒期咳嗽的方法，同时减少高剂量阿片类药物的不良反应。我们假设在甲状腺切除术患者中，与单独使用高剂量瑞芬太尼输注相比，在苏醒期间单次给予右美托咪定联合低剂量瑞芬太尼输注不会减弱对咳嗽的抑制作用。
169 名接受甲状腺切除术的患者按照 1:1 的比例被随机分为 DR 组或 R 组。每组患者在手术结束时接受右美托咪定（0.5μg/kg）和效应室浓度（Ce）为 1ng/mL 的低剂量瑞芬太尼输注或生理盐水输注，以及 Ce 为 2ng/mL 的高剂量瑞芬太尼输注 10 分钟。瑞芬太尼维持至气管拔管。主要终点是拔管时咳嗽的严重程度，采用四点量表评估其非劣效性。为了比较苏醒期间咳嗽的发生率，还在三个时间点测量咳嗽等级：拔管前、拔管时和拔管后。还评估了苏醒时间、血流动力学和呼吸特征、疼痛和术后恶心呕吐的优势。气管拔管时咳嗽等级差异的 95%置信区间<0.9，表明右美托咪定联合低剂量瑞芬太尼输注的单次剂量具有非劣效性。两组咳嗽发生率相似。DR 组气管拔管期间的血流动力学变化减弱，但苏醒延迟。两组使用止吐药的情况相似，但 DR 组呕吐发生率较低。
在七氟醚-瑞芬太尼麻醉苏醒期间，单次给予右美托咪定（0.5μg/kg）联合 Ce 为 1ng/mL 的低剂量瑞芬太尼输注与单独使用 Ce 为 2ng/mL 的高剂量瑞芬太尼输注相比，在抑制咳嗽方面并不劣于后者。
