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Low-dose remifentanil infusion during ventilator weaning and tracheal extubation in postoperative intensive care unit patients sedated with propofol-remifentanil: a randomised clinical trial

Authors
 SY Kim  ;  SY Yang  ;  SW Na  ;  YY Jo  ;  SO Koh 
Citation
 Anaesthesia and Intensive Care, Vol.40(4) : 656-662, 2012 
Journal Title
 Anaesthesia and Intensive Care 
ISSN
 0310-057X 
Issue Date
2012
Abstract
Discontinuation of sedatives for ventilator weaning and extubation can be associated with hyperdynamic responses, including hypertension and tachycardia. We examined the effects of a maintained low dose of remifentanil infusion on cardiovascular responses and coughing during extubation in postoperative intensive care unit patients sedated with propofol-remifentanil. Fifty patients who required mechanical ventilation after major abdominal surgery were randomised into remifentanil group (n=25) or control group (n=25). Sedation during mechanical ventilation was maintained with remifentanil and propofol via a target-controlled infusion system. These drugs were titrated to the target sedation range, bispectral index values of 60 to 75 and Richmond Agitation Sedation Scale values of -3 to -2. When weaning was initiated, propofol was stopped in both groups. In the control group, remifentanil infusion was also stopped; in the remifentanil group, remifentanil infusion was maintained until extubation at a target effect site concentration of 1.0 ng/ml. Extubation was performed if the patient's respiratory, haemodynamic states were stable and if the patient was able to follow commands. Heart rate, mean arterial pressure and cough severity were evaluated. The mean arterial pressure, heart rate and cough severity did not differ between the two groups during extubation. The time from stopping of propofol infusion to extubation was significantly longer in the remifentanil group compared to that in the control group (P=0.020). Maintaining a low-dose remifentanil infusion during ventilator weaning, delayed tracheal extubation without any differences in haemodynamic changes or coughing in postoperative intensive care unit patients.
Full Text
http://www.aaic.net.au/Document/?D=20110720
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Koh, Shin Ok(고신옥)
Kim, So Yeon(김소연) ORCID logo https://orcid.org/0000-0001-5352-157X
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Yang, So Young(양소영)
Jo, Youn Yi(조윤이)
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/89467
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