Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention.
Ji-Hye KwonYoung Hee ShinNam-Su GilJungchan ParkYoon Joo ChungTae Soo HahmJi Seon JeongPublished in: PloS one (2019)
During emergence from general anesthesia, coughing caused by the endotracheal tube frequently occurs and is associated with various adverse complications. In patients undergoing endovascular neurointervention, achieving smooth emergence from general anesthesia without coughing is emphasized since coughing is associated with intracranial hypertension. Therefore, the up-and-down method was introduced to determine the effective effect-site concentration (Ce) of remifentanil to prevent coughing in 50% and 95% (EC50 and EC95) of patients during emergence from sevoflurane anesthesia for endovascular neurointervention. A total of 43 participants, American Society of Anesthesiologists class I or II participants, aged from 20 to 70 years who were undergoing endovascular neurointervention through transfemoral catheter for cerebrovascular disease were enrolled. Using the up-and-down method with isotonic regression, the EC50 and EC95 of remifentanil to prevent coughing during emergence from sevoflurane anesthesia were determined. We also investigated differences of hemodynamic and recovery profiles between the cough suppression group and the cough group. In total, 38 of 43 patients were included for estimation of EC50 and EC95. The EC50 and EC95 of remifentanil to prevent coughing were 1.42 ng/mL (95% confidence interval [CI], 1.28-1.56 ng/mL) and 1.70 ng/mL (95% CI, 1.67-2.60 ng/mL), respectively. There was comparable emergence and recovery data between the cough suppression group (n = 22) and the cough group (n = 16). However, the Ce of remifentanil and total dose of remifentanil were significantly higher in the cough suppression group (P = 0.002 and P = 0.004, respectively). Target-controlled infusion of remifentanil at 1.70 ng/mL could effectively prevent extubation-related coughing in 95% of neurointervention patients, which could ensure smooth emergence.
Keyphrases
- end stage renal disease
- patients undergoing
- ejection fraction
- newly diagnosed
- chronic kidney disease
- prognostic factors
- heart failure
- blood pressure
- cardiac surgery
- coronary artery disease
- low dose
- mass spectrometry
- risk factors
- emergency department
- optical coherence tomography
- intensive care unit
- patient reported outcomes
- artificial intelligence
- aortic valve replacement
- electronic health record
- transcatheter aortic valve implantation
- aortic stenosis
- aortic dissection