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Efficacy of a single dose of dexmedetomidine for cough suppression during anesthetic emergence: a randomized controlled trial

Authors
 Jeong Soo Lee  ;  Seung Ho Choi  ;  Young Ran Kang  ;  Yunhee Kim  ;  Yon Hee Shim 
Citation
 CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE, Vol.62(4) : 392-398, 2015 
Journal Title
CANADIAN JOURNAL OF ANESTHESIA-JOURNAL CANADIEN D ANESTHESIE
ISSN
 0832-610X 
Issue Date
2015
MeSH
Adrenergic alpha-2 Receptor Agonists/administration & dosage* ; Adrenergic alpha-2 Receptor Agonists/adverse effects ; Adrenergic alpha-2 Receptor Agonists/therapeutic use ; Adult ; Airway Extubation ; Anesthesia Recovery Period ; Anesthesia, General/methods* ; Arterial Pressure/drug effects ; Cough/epidemiology ; Cough/etiology ; Cough/prevention & control* ; Dexmedetomidine/administration & dosage* ; Dexmedetomidine/adverse effects ; Dexmedetomidine/therapeutic use ; Double-Blind Method ; Female ; Heart Rate/drug effects ; Humans ; Incidence ; Male ; Methyl Ethers/administration & dosage ; Middle Aged ; Piperidines/administration & dosage ; Thyroidectomy/methods
Keywords
Mean Arterial Pressure ; Sevoflurane ; Remifentanil ; Dexmedetomidine ; Tracheal Extubation
Abstract
PURPOSE: Maintenance of a remifentanil infusion during anesthetic emergence has been reported to decrease the incidence of coughing and thereby help to ensure a smooth emergence. It may, however, cause respiratory depression and possibly delay emergence. The purpose of this study was to investigate the effect of a single dose of dexmedetomidine combined with a low-dose remifentanil infusion on cough suppression during emergence from general anesthesia.

METHODS: American Society of Anesthesiologists physical status I-II adults undergoing elective thyroidectomy under sevoflurane anesthesia were recruited and randomly allocated to receive either dexmedetomidine 0.5 μg·kg(-1) iv (Group D, n = 70) or saline (Group S, n = 71), each combined with a low-dose remifentanil infusion ten minutes before the end of surgery. Coughing was assessed using a four-point scale. The respiratory rate (RR), heart rate (HR), and mean arterial pressure were also recorded.

RESULTS: The incidence of coughing was lower in Group D than in Group S (64% vs 91%, respectively; mean difference 27%; 95% confidence interval [CI] 13 to 41; P < 0.001). The median cough grade at extubation was also lower in Group D. Mean arterial pressure and HR were elevated in Group S during tracheal extubation but were similar to baseline values in Group D. There was no difference in RR between the two groups throughout the study. A small delay in extubation was observed in Group D (3 minutes longer than Group S; 95% CI 2 to 4; P < 0.001).

CONCLUSION: Compared with an infusion of low-dose remifentanil alone, the addition of a single dose (0.5 μg·kg(-1)) of dexmedetomidine during emergence from sevoflurane-remifentanil anesthesia was effective in attenuating coughing and hemodynamic changes and did not exacerbate respiratory depression after thyroid surgery. This trial was registered at Clinicaltrial.gov, identifier: NCT01774305.
Full Text
http://link.springer.com/article/10.1007%2Fs12630-014-0295-6
DOI
10.1007/s12630-014-0295-6
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ran(강영란)
Shim, Yon Hee(심연희) ORCID logo https://orcid.org/0000-0003-1921-3391
Lee, Jeong Soo(이정수) ORCID logo https://orcid.org/0000-0002-8947-3706
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139620
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