Target concentrations of remifentanil with propofol to blunt coughing during intubation, cuff inflation, and tracheal suctioning.
BACKGROUND
The target blood concentrations of propofol and remifentanil, when used in combination, required to blunt the cough response to tracheal intubation, cuff inflation, and tracheal suctioning without neuromuscular blocking agents are not known.


METHODS
In a randomized prospective study, 81 patients were enrolled to determine which of three target remifentanil blood concentrations was required to blunt coughing during intubation, cuff inflation, and tracheal suctioning. Anaesthesia was achieved with propofol at a steady effect-site concentration of 3.5 microg ml(-1). The target blood remifentanil concentrations were 5, 10, or 15 ng ml(-1). These concentrations were maintained for 12 min before intubation.


RESULTS
There was no cough response to intubation in more than 74% of patients and no significant difference in the incidence of coughing with intubation between the three groups. Significant difference in coughing, diminishing with increasing remifentanil target concentration, was observed with cuff inflation (P=0.04) and tracheal suctioning (P=0.007). Bradycardia and hypotension was more frequent with the remifentanil target concentration of 15 ng ml(-1). Tracheal suctioning resulted in more coughing than intubation (P=0.01) or cuff inflation (P=0.004).


CONCLUSIONS
Target remifentanil blood concentrations of 5, 10, and 15 ng ml(-1) associated with a 3.5 microg ml(-1) propofol target blood concentration provided good intubating conditions and absence of cough about 75% of the time. Higher target remifentanil concentrations were associated with less coughing during tracheal tube cuff inflation and tracheal suctioning.
Département d'Anesthésie et de Réanimation and Département de Chirurgie Maxillo-Faciale, Centre Hospitalo-Universitaire Nord, Marseille, France. marc.leone@ap-hm.fr
M
M
Leone
S
S
Rousseau
M
M
Avidan
A
A
Delmas
X
X
Viviand
L
L
Guyot
C
C
Martin
D000293:Adolescent; D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000097:blood*; D003371:Cough / Q000209:etiology / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000097:blood*; D015742:Propofol / Q000008:administration & dosage / Q000097:blood*; D011446:Prospective Studies; D000077208:Remifentanil; D013396:Suction / Q000009:adverse effects
D019162:Anesthetics, Combined; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol