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Determination of EC95 of remifentanil for smooth emergence from propofol anesthesia in patients undergoing transsphenoidal surgery

 Seung Ho Choi  ;  Kyeong Tae Min  ;  Jeong Rim Lee  ;  Kwan Woong Choi  ;  Kyung Hwa Han  ;  Eui Hyun Kim  ;  Hye Jin Oh  ;  Jae Hoon Lee 
 Journal of Neurosurgical Anesthesiology, Vol.27(2) : 160-166, 2015 
Journal Title
 Journal of Neurosurgical Anesthesiology 
Issue Date
Adult ; Algorithms ; Anesthesia Recovery Period ; Anesthesia, Intravenous* ; Anesthetics, Intravenous/administration & dosage* ; Female ; Humans ; Hypophysectomy/methods* ; Male ; Middle Aged ; Piperidines/administration & dosage* ; Pituitary Neoplasms/surgery ; Propofol* ; Sphenoid Bone/surgery* ; Treatment Outcome
cough ; endotracheal tube ; remifentanil ; targetcontrolled infusion ; transsphenoidal hypophysectomy
BACKGROUND: In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. MATERIALS AND METHODS: A total of 41 patients undergoing transsphenoidal hypophysectomy, aged 20 to 65 years, with an ASA physical status of I or II, were enrolled. For all participants, anesthesia was induced and maintained with a target-controlled infusion of remifentanil and propofol using predicted effect-site concentration (Ce). A biased coin design up-and-down sequential allocation and isotonic regression method were used to determine the remifentanil EC95 to prevent emergence coughing. In addition, we observed recovery profiles after anesthesia. RESULTS: According to the study design, 19 patients received remifentanil 2.6 ng/mL Ce and 22 patients received a lower Ce, ranging from 1.0 to 2.2 ng/mL. The EC95 of remifentanil to prevent coughing was estimated as 2.51 ng/mL (95% confidence interval, 2.28-2.57 ng/mL). Despite the exclusion of 1 case because of delayed emergence, 17 of 18 patients receiving 2.6 ng/mL of remifentanil had bradypnea (<10 breaths/min) until 3 minutes after extubation. However, end-tidal carbon dioxide was maintained below 55 mm Hg during anesthetic emergence and respiratory rate recovered within 20 minutes of admission to the postanesthetic care unit. CONCLUSIONS: The EC95 of remifentanil for smooth emergence from anesthesia was 2.51 ng/mL after transsphenoidal hypophysectomy.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Min, Kyeong Tae(민경태) ORCID logo https://orcid.org/0000-0002-3299-4500
Lee, Jae Hoon(이재훈) ORCID logo https://orcid.org/0000-0001-6679-2782
Lee, Jeong Rim(이정림) ORCID logo https://orcid.org/0000-0002-7425-0462
Choi, Kwan Woong(최관웅)
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
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