Maintaining remifentanil infusion benefits recovery

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Maintaining remifentanil infusion benefits recovery MedWire News: Maintaining a remifentanil infusion during the emergence and tracheal extubation minimizes cardiovascular changes and coughing in patients after total intravenous anesthesia (TIVA), without delaying recovery, researchers report. “It is common for anesthesiologists to terminate anesthetic agents at the end of surgery to initiate emergence,” note J Kang (Kyung Hee University, Seoul, Republic of Korea) and colleagues. “Our original idea is not to add new agents, but to maintain the low-dose remifentanil infusion already being used during anesthesia.” The researchers randomly allocated 40 patients undergoing endoscopic sinus surgery under general anesthesia using total intravenous anesthesia (propofol and remifentanil) to a control group or remifentanil group during emergence from anesthesia. The remafentanil group continued to receive an infusion of remifentanil at a target organ concentration of 1.5 ng/mL at the end of surgery, when propofol was ceased, until extubation, whereas both remifentanil and propofol were stopped in the control group. The two treatment groups did not differ significantly with regard to gender ratio, weight, height, time to eye opening, time to extubation, nausea rate, visual analog scale, or time to discharge. At baseline, heart rate (HR) and mean arterial pressure (MAP) were similar in the two groups. However, they were both significantly higher in the control group compared with the remifentanil group 2 minutes after the end of surgery, at tracheal extubation, and 2 minutes after tracheal extubation, with an average difference of about 24 beats per minute and 17 mmHg, respectively. Moderate or severe coughing was only seen in the control group, affecting eight patients. Only one patient in the control group experienced no coughing compared with 12 patients in the remifentanil group. Kang et al conclude in the British Journal of Anaesthesia: “Maintaining a remifentanil infusion during emergence from anesthesia is a simple but effective method in reducing hemodynamic changes and cough reflex activities associated with tracheal extubation with minimal effects on delaying recovery from anesthesia.” MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009. Nho J-S, Lee S-Y, Kang J-M, et al. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation. British Journal of Anaesthesia 2009; 103: 817-821.