The effect of remifentanil on cough suppression after endoscopic sinus surgery: a randomized study.
BACKGROUND
Excessive coughing may increase the risk of complications after sinus surgery. We hypothesized that remifentanil would decrease the incidence and severity of coughing after endoscopic sinus surgery with propofol and remifentanil anaesthesia.


METHODS
Ninety patients scheduled for endoscopic sinus surgery were randomly assigned into three groups. Propofol was stopped at the completion of the surgical procedure. The remifentanil infusion was adjusted to an effect-site concentration of 1.5, 2.0 or 2.5 ng/ml, 10 min before the anticipated end of surgery, in each of the three groups (RF₁(.)₅, RF₂(.)₀ and RF₂(.)₅) and continued until after extubation. The incidence and severity of coughing was evaluated on a scale from 0 to 3.


RESULTS
The proportion of patients who did not cough was significantly higher in the RF₂(.)₀ (67.5%, 95% CI: 59.1– 75.9%) and RF₂(.)₅ (74.2%, 95% CI: 66.4–82.0%) groups than in the RF₁(.)₅ group (35.%, 95% CI: 26.5–43.5%) (P < 0.01). The incidence of grade 2 or 3 coughing was significantly higher in the RF₁(.)₅ group (grade 2: 15.1%, grade 3: 6.7%) than in the RF₂(.)₀ group (grade 2: 5.0%, grade 3: 0%) and the RF₂(.)₅ group (grade 2: 4.2%, grade 3: 0%) (P < 0.05). There was no statistically significant difference in the time to extubation among the three groups.


CONCLUSIONS
Maintaining anaesthesia with remifentanil to the end of the surgery, until after extubation, can suppress coughing without prolonging the recovery from anaesthesia. This effect is dose dependent and is more pronounced at higher concentrations of remifentanil (2.0 or 2.5 ng/ml).
Department of Anesthesiology, EENT Hospital, Fudan University, Shanghai, China.
J
J
Chen
W
W
Li
D
D
Wang
X
X
Hu
D000293:Adolescent; D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D056805:Consciousness Monitors; D003371:Cough / Q000517:prevention & control*; D004311:Double-Blind Method; D004724:Endoscopy; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D010256:Paranasal Sinuses / Q000601:surgery*; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D000077208:Remifentanil; D012907:Smoking / Q000009:adverse effects; D055815:Young Adult
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil