title: Remifentanil infusion during emergence moderates hemodynamic and cough responses to the tracheal tube: A randomized controlled trial.
abstract: OBJECTIVE
  To examine the severity of cough and straining at the time of emergence from anesthesia.
  
  
  METHODS
  Double-blind randomized, placebo-controlled study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Sixty-two American Society of Anesthesiologists 2 patients undergoing craniotomy and excision of supratentorial cerebral tumors.
  
  
  METHODS
  Intravenous infusion of remifentanil (REM) at 0.05 μg/kg/min or normal saline (NS) upon termination of the surgical procedure.
  
  
  METHODS
  Heart rate (HR) and mean arterial pressure (MAP) along with the frequency and severity of cough response (Modified Minogue Scale) to the endotracheal tube were recorded at different time points. The frequency of cough and straining was analyzed with χ(2) tests. HRs and MAP were analyzed by repeated-measures analysis of variance between REM and NS groups.
  
  
  RESULTS
  There was no case of significant cough in the REM group, and all of the patients in the NS group developed some extent of cough varying from mild retching to severe coughing episodes (P < .001). Both the HR and MAPs were consistently lower in the REM group compared to the NS group.
  
  
  CONCLUSIONS
  Infusion of REM at the end of craniotomy procedures results in significant reduction of the frequency and severity of coughing and straining. Compared to placebo, REM moderates increases in MAP upon emergence from general anesthesia until the time of extubation.
authors.affiliation: Department of Anesthesiology, Firoozghar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Ghodraty
authors.affiliation: Department of Anesthesiology, Rasoul Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Valiollah
authors.initials: V
authors.lastname: Hasani
authors.affiliation: Department of Anesthesiology, Firoozghar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Bagheri-Aghdam
authors.affiliation: Department of Anesthesiology, Firoozghar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Mahdi
authors.initials: MM
authors.lastname: Zamani
authors.affiliation: Department of Anesthesiology, Firoozghar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Pournajafian
authors.affiliation: Department of Anesthesiology, Firoozghar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Faranak
authors.initials: F
authors.lastname: Rokhtabnak
authors.affiliation: Department of Anesthesiology, Firoozghar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Kholdebarin
authors.affiliation: Department of Anesthesiology & Perioperative Care, VA Western NY Healthcare System, SUNY-Buffalo, Buffalo, NY, USA. Electronic address: nnader@buffalo.edu.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000762:Anesthesia Recovery Period; D062186:Arterial Pressure / Q000187:drug effects; D003371:Cough / Q000517:prevention & control*; D003399:Craniotomy; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010880:Piperidines; D000077208:Remifentanil
keywords: Coughing; Emergence; Extubation; Hemodynamic; Remifentanil; Straining