Effect-site concentration of remifentanil for preventing cough during emergence in elderly patients undergoing nasal surgery: a comparison with adult patients.
OBJECTIVE
Prevention of cough during emergence after nasal surgery is important for avoiding surgical site bleeding. We investigated the remifentanil effect-site concentration in 50% (EC50) of the elderly patients undergoing nasal surgery for smooth emergence without cough and compared it with that of adult patients.


METHODS
Twenty-two elderly (aged 65-80 years) and 25 adult patients (aged 20-60 years) with an American Society of Anesthesiologists physical status I/II undergoing nasal surgery were enrolled. Anesthesia was maintained with sevoflurane and remifentanil. Remifentanil EC50 and EC95 for preventing cough were determined using the modified Dixon's up-and-down method and isotonic regression with bootstrapping approach. Recovery profiles were also recorded.


RESULTS
With Dixon's up-and-down method, the EC50 of remifentanil in elderly patients (2.40±0.25 ng/mL) was not significantly different from that of adults (2.33±0.30 ng/mL) (P=0.687). With isotonic regression, the EC95 of remifentanil in elderly patients (3.32 [95% confidence interval: 3.06-3.38] ng/mL) was not significantly different from that of adults (3.30 [95% confidence interval: 2.96-3.37] ng/mL). However, eye opening time (14.1±3.8 vs 12.0±2.9 seconds), extubation time (17.2±4.1 vs 14.0±3.0 seconds), and postanesthesia care unit duration (44.5±7.6 vs 38.7±3.4 minutes) in elderly patients were significantly longer than those in adults (P<0.05).


CONCLUSIONS
Remifentanil EC50 for preventing cough after nasal surgery with sevoflurane anesthesia did not differ between elderly and adult patients. However, delayed awakening and respiratory adverse events may warrant attention in elderly patients.
Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon.
Ji Young
JY
Yoo
Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon.
Jong Yeop
JY
Kim
Department of Anaesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
Hyun Jeong
HJ
Kwak
Department of Anaesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea.
Dong Chul
DC
Lee
Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon.
Go Wun
GW
Kim
Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon.
Sook Young
SY
Lee
Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon.
Yun Jeong
YJ
Chae
cough; elderly; extubation; remifentanil; sevoflurane
Anesthesiol Clin North America. 2000 Mar;18(1):1-29, v
10934997
Circulation. 2009 Jan 27;119(3):e21-181
19075105
Chest. 1995 Jan;107(1):290-1
7813298
Anesthesiology. 1997 Jan;86(1):10-23
9009935
Anesth Analg. 1999 Oct;89(4 Suppl):S7-14
10511072
Yonsei Med J. 2014 May;55(3):807-14
24719152
Anesthesiology. 1997 Jan;86(1):24-33
9009936
Anesthesiology. 2007 Jul;107(1):144-52
17585226
Anesth Analg. 1993 Nov;77(5):1012-7
8214700
Eur J Pharmacol. 1990 Oct 9;187(2):281-6
2272363
J Clin Anesth. 1995 Feb;7(1):89-91
7772368
Rev Esp Cardiol. 2011 Aug;64(8):697-712
21723657
Eur J Pharmacol. 1991 Oct 2;203(1):153-6
1665789
Br J Anaesth. 2009 Dec;103(6):817-21
19864308
Anesth Analg. 2009 Apr;108(4):1157-60
19299779
Br J Anaesth. 2009 Jun;102(6):775-8
19411668
Chest. 2006 Aug;130(2):362-70
16899833
Acta Anaesthesiol Scand. 2012 Apr;56(4):498-503
22220983
Neurosci Biobehav Rev. 1991 Spring;15(1):47-50
2052197
Clin Pharmacokinet. 1995 Aug;29(2):80-94
7586903
Age Ageing. 1997 May;26(3):185-8
9223713
Life Sci. 1995;57(16):PL231-5
7564887
Anesthesiology. 2001 Dec;95(6):1362-70
11748393
J Neurosurg Anesthesiol. 2015 Apr;27(2):160-6
25105828
Cough. 2011 Jun 28;7(1):3
21711545
Anesthesiology. 2009 May;110(5):1176-81
19352149
J Appl Physiol (1985). 2009 Apr;106(4):1038-49
19196914
Laryngoscope. 2013 Dec;123(12):3105-9
23686891