Smooth emergence inmenundergoing nasal surgery: the effect site concentration of remifentanil for preventing cough after sevoflurane-balanced anaesthesia

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Abstract

Background:

Suppression of cough during emergence after nasal surgery is practical to avoid bleeding from the surgical site. Previously recommended effect-site concentration of remifentanil for preventing cough during emergence is restricted to female patients undergoing thyroid surgery, so we evaluated effective effect-site concentration of remifentanil for preventing cough during emergence for men undergoing nasal surgery.

Methods:

Twenty-four American Society of Anesthesiologists (ASA) physical status I or II, between the ages of 18 and 60 years old, non-smoker male patients undergoing nasal surgery were enrolled in this study. The effective effect-site concentration for 50% of patients (EC50) and and that for 95% of patients (EC95) of remifentanil for preventing cough were determined by Dixon's up-and-down method and by isotonic regression method with a bootstrapping approach. Haemodynamic variables were compared in patients with cough and without cough during emergence.

Results:

The EC50 of remifentanil for preventing cough during emergence by Dixon's method was 2.17 ng/ml [standard deviation (SD) 0.38]. The estimated EC50 and EC95 of remifentanil using isotonic regression model with a bootstrapping approach were 2.35 ng/ml [95% confidence interval (CI) 1.89–2.66] and 2.94 ng/ml (95% CI 2.83–2.97), respectively. Mean arterial pressure and heart rate were significantly higher in patients with cough during emergence. Three out of 13 patients that received more than 2.5 ng/ml of remifentanil experienced a brief episode of bradypnea.

Conclusions:

The EC95 of remifentanil for preventing cough in men after nasal surgery is 2.94 ng/ml. Remifentanil target-controlled infusion with established effect-site concentration could suppress cough in men during emergence from sevoflurane anaesthesia after nasal surgery, though reversible respiratory depression might arise at high effect-site concentration of remifentanil.

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