title: Effectiveness of high dose remifentanil in preventing coughing and laryngospasm in non-paralyzed patients for advanced bronchoscopic procedures.
abstract: BACKGROUND
  Anesthesia for bronchoscopy presents unique challenges, as constant stimulus due to bronchoscope needs to be obtunded using drugs with a minimal post-procedure residual effect. Remifentanil for maintenance is an ideal choice, but optimal doses are yet to be determined.
  
  
  METHODS
  Bronchoscopic procedures were prospectively evaluated for 4 months studying the frequency of complications and anesthesia techniques. Anesthesia was maintained on remifentanil/propofol infusion avoiding neuromuscular blockers. Laryngeal mask airway was used for the controlled ventilation (with high oxygen concentration) that also served as a conduit for bronchoscope insertions. Anesthesiologists were blinded to the study (avoiding performance bias) and the Pulmonologist was blinded to the anesthesia technique (to document unbiased procedural satisfaction scores). Procedures were divided into 2 groups based on the dose of remifentanil used for maintenance: Group-H (high dose -0.26 to 0.5 μg/kg/min and Group-NH (non-high dose ≤0.25 μg/kg/min).
  
  
  RESULTS
  Observed 75 procedures were divided into Group-H (42) and Group-NH (33). Number of statistical difference was found in demography, procedural profile, hemodynamic parameters and total phenylephrine used. Chi-square test showed Group-NH had significantly higher frequency of laryngospasm (P = 0.047) and coughing (P = 0.002). The likelihood ratio of patient coughing and developing laryngospasm in Group-NH was found to be 4.56 and 10.97 times respectively. Minimum pulse-oximeter saturation was statistically higher in Group-H (98.80% vs. 96.50% P = 0.009). Pulmonologist satisfaction scores were significantly better in Group-H.
  
  
  CONCLUSIONS
  High dose of remifentanil infusion is associated with a lower incidence of coughing and laryngospasms during bronchoscopy. Simultaneously, it improves Pulmonologist's satisfaction and procedural conditions.
authors.affiliation: Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Basavana Gouda
authors.initials: BG
authors.lastname: Goudra
authors.affiliation: Department of Anesthesia, PGIMER, Chandigarh, India.
authors.forename: Preet Mohinder
authors.initials: PM
authors.lastname: Singh
authors.affiliation: Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Amit K
authors.initials: AK
authors.lastname: Manjunath
authors.affiliation: Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Reihmer
authors.affiliation: Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Haas
authors.affiliation: Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Lanfranco
authors.affiliation: Department of Anesthesiology and Perioperative Medicine, Drexel University College of Medicine, Philadelphia, USA.
authors.forename: Ashish C
authors.initials: AC
authors.lastname: Sinha
authors.affiliation: Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: Kassem
authors.initials: K
authors.lastname: Harris
keywords: High dose remifentanil; laryngospasm during bronchoscopy; remifentanil for bronchoscopy