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

Authors
 E. M. CHOI  ;  W-K. PARK  ;  S-H. CHOI  ;  S. SOH  ;  J-R. LEE 
Citation
 ACTA ANAESTHESIOLOGICA SCANDINAVICA, Vol.56(4) : 498-503, 2012 
Journal Title
 ACTA ANAESTHESIOLOGICA SCANDINAVICA 
ISSN
 0001-5172 
Issue Date
2012
MeSH
Adolescent ; Adult ; Anesthesia, Inhalation ; Anesthetics, Inhalation/adverse effects* ; Blood Pressure/drug effects ; Cough/prevention & control* ; Heart Rate/drug effects ; Humans ; Male ; Methyl Ethers/adverse effects* ; Middle Aged ; Nose/surgery* ; Piperidines/therapeutic use*
Keywords
Adolescent ; Adult ; Anesthesia, Inhalation ; Anesthetics, Inhalation/adverse effects* ; Blood Pressure/drug effects ; Cough/prevention & control* ; Heart Rate/drug effects ; Humans ; Male ; Methyl Ethers/adverse effects* ; Middle Aged ; Nose/surgery* ; Piperidines/therapeutic use*
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 (EC(50) ) and and that for 95% of patients (EC(95) ) 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 EC(50) of remifentanil for preventing cough during emergence by Dixon's method was 2.17 ng/ml [standard deviation (SD) 0.38]. The estimated EC(50) and EC(95) 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 EC(95) 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.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/j.1399-6576.2011.02620.x/abstract
DOI
22220983
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Park, Wyun Kon(박윤곤)
Soh, Sa Rah(소사라) ORCID logo https://orcid.org/0000-0001-5022-4617
Lee, Jeong Rim(이정림) ORCID logo https://orcid.org/0000-0002-7425-0462
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89350
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