Comparison between remifentanil target-controlled infusion and single-dose dexmedetomidine administration for smooth emergence from general sevoflurane anesthesia : a randomized, controlled study

Abstract

Background: Remifentanil target-controlled infusion (TCI) and single-dose dexmedetomidine administration are known to attenuate airway responses such as coughing and hemodynamic stimulation during anesthetic recovery. We compared the effects of these two drugs on coughing during emergence from general sevoflurane anesthesia.Methods: We enrolled 70 patients, all females aged 20 - 60 yr and ASA I-II, who underwent general anesthesia for elective thyroidectomy. The patients were randomly assigned to remifentanil (Group R, n=35) or dexmedetomidine (Group D, n=35). For both groups, anesthesia was maintained with sevoflurane and remifentanil; however remifentanil was stopped in Group D 15 minutes before the end of surgery and was replaced with dexmedetomidine 0.5 mcg/kg 5 minutes before the end of surgery, while an effect-site concentration of 2.0 ng/mL of remifentanil TCI was maintained until extubation in Group R. Cough grade, hemodynamic values and recovery profiles were evaluated during emergence.Results: Cough grade was significantly lower in Group R than in Group D. Hemodynamic values (heart rate, mean arterial pressure) were observed to be within the normal range for both groups. No desaturation events were recorded during the study, and there were no significant differences in time to extubation and duration of PACU stay between the two roups. Conclusions: Remifentanil TCI reduces coughing during emergence from general anesthesia more effectively than single-dose dexmedetomidine. However, dexmedetomidine may be useful as an alternative to remifentanil TCI when considering hemodynamic stability during emergence.