Yonsei Med J.  2015 Mar;56(2):529-534. 10.3349/ymj.2015.56.2.529.

Optimal Effect-Site Concentration of Remifentanil for Inhibiting Response to Laryngeal Mask Airway Removal during Emergence

• Park SJ
• Baek JY
• Jee DL

• KMID: 2070034
• DOI: http://doi.org/10.3349/ymj.2015.56.2.529

Abstract

PURPOSE
This randomized, controlled, double-blind study was designed to determine the optimal dose of remifentanil for preventing complications associated with the removal of a laryngeal mask airway (LMA) without delaying emergence.
MATERIALS AND METHODS
This study randomly assigned 128 patients to remifentanil effect-site concentrations (Ce) of 0 ng/mL (group R0), 0.5 ng/mL (group R0.5), 1.0 ng/mL (group R1.0), and 1.5 ng/mL (group R1.5) during emergence. The emergence and recovery profiles were recorded. Adverse events such as coughing, airway obstruction, breath-holding, agitation, desaturation, nausea, and vomiting were also evaluated.
RESULTS
The number of patients with respiratory complications such as coughing and breath-holding was significantly lower in the R1.0 and R1.5 groups than in the R0 group (p<0.05). Emergence agitation also decreased in the R1.0 and R1.5 groups (p<0.0083). The time to LMA removal was significantly longer in the R1.5 group than in the other groups (p<0.05).
CONCLUSION
Maintaining a remifentanil Ce of 1.0 ng/mL during emergence may suppress adverse events such as coughing, breath-holding, and agitation following the removal of LMA without delayed awakening.

Keyword

Emergence; laryngeal mask airway; remifentanil

MeSH Terms

Adult
Airway Management/*methods
Anesthesia Recovery Period
Anesthetics, Intravenous/*administration & dosage
Cough/prevention & control
Device Removal
Dose-Response Relationship, Drug
Double-Blind Method
Female
Humans
Infusions, Intravenous
Laryngeal Masks/*adverse effects
Male
Middle Aged
Piperidines/*administration & dosage
Postoperative Complications/prevention & control
Psychomotor Agitation
Vomiting/prevention & control
Anesthetics, Intravenous
Piperidines

Figure

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  Fig. 1 CONSORT diagram. Ce, effect-site concentration; LMA, laryngeal mask airway.

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  Fig. 2 Changes in heart rate and mean arterial pressure during emergence. Data are expressed mean±SD. T0, entry into the operation room; T4, 2 minutes after the end of the surgery; T5, immediately prior to removal of the laryngeal mask airway; T6, 2 minutes after removal; T7, 10 minutes after arrival in the PACU. *p<0.05, compared to R0 group. PACU, post anesthesia care unit.

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