Moo Il Kwon

Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation

BACKGROUND Emergence from anaesthesia and tracheal extubation can be associated with hyperdynamic circulatory responses. We examined the effects of maintaining a remifentanil infusion on recovery profiles such as coughing and cardiovascular responses after general anaesthesia. METHODS Forty patients undergoing endoscopic sinus surgery under general anaesthesia using total i.v. anaesthesia (propofol and remifentanil) were randomly allocated to a control group (n=20) or remifentanil group (n=20) during emergence from anaesthesia. At the end of surgery, propofol was ceased and the infusion of remifentanil was stopped in the control group and maintained in the remifentanil group at a target organ concentration of 1.5 ng ml(-1) until extubation. Heart rate (HR), mean arterial pressure (MAP), and recovery profiles were measured and evaluated. RESULTS There was no significant difference in sex ratio, age, weight, height, time to eye opening, time to extubation, nausea, visual analogue scale, and time to discharge. Increases in HR and MAP occurred during emergence in the control group compared with baseline values. Increases in HR were attenuated in the remifentanil group and MAP decreased during recovery compared with baseline values. HR and MAP values were significantly higher in the control group [103 (23) beats min(-1), 129 (17) mm Hg] compared with the remifentanil group [79 (17) beats min(-1), 112 (15) mm Hg] during emergence and tracheal extubation. Moderate or severe coughing was observed only in the control group (8/20 vs 0/20, P<0.001). CONCLUSIONS Maintaining a remifentanil infusion reduced haemodynamic changes and coughing associated with tracheal extubation almost without significantly delaying recovery from anaesthesia.

Audiovisual stimulation with synchronized pulsed tones and flickering lights set at a delta frequency can induce a sedative effect.

The perioperative period is a source of significant fear and anxiety for patients. Therefore, anxiolytic and sedative drugs are administered routinely, before and during surgery [1]. However, a larger dose of sedatives can delay the recovery in the ambulatory setting and be associated with an increased risk for complications.