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Korean J Anesthesiol. 2009 Jun;56(6):624-627. English. Randomized Controlled Trial.
Kim JY , Kim JY , Park SY , Jung WS , Kwak HJ .
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea.
Department of Anesthesiology and Pain Medicine, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea.

BACKGROUND: A reflex cough is often observed after an intravenous (IV) bolus of remifentanil. Since ketamine was reported to be effective in modulating the cough reflex, this prospective, randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy of pretreatment with ketamine on remifentanil-induced cough. METHODS: 320 patients undergoing general anesthesia for elective surgery were randomly allocated into two groups to receive either IV ketamine 0.1 mg/kg (ketamine group, n = 156) or 0.9% saline (saline group, n = 154) 1 min before administration of remifentanil at a target effect-site concentration of 5 ng/ml. Severity of cough was graded (mild, 1-2; moderate, 3-4; and severe, 5 or >5). RESULTS: The overall incidence of cough was significantly higher in the saline group (43/154 patients; 0.28, 95% CI 0.21, 0.36) than that in the ketamine group (18/156 patients; 0.12, 95% CI 0.07, 0.18) (P < 0.001). However, there was no significant difference in the severity and the onset time of cough between the groups. CONCLUSIONS: IV ketamine 0.1 mg/kg one minute before remifentanil was effective in suppressing remifentanil-induced cough without affecting the severity and onset time.

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