F. Ariza, Gustavo Cruz, D. Castaño, I. Quintero, Laura Suárez, Mauricio Burbano, Einar Burbano Burbano
{"title":"https://medcraveonline.com/JACCOA/anesthetic-and-hemodynamic-management-in-patients-with-different-approaches-for-multiple-neurological-pathologies-case-report.html","authors":"F. Ariza, Gustavo Cruz, D. Castaño, I. Quintero, Laura Suárez, Mauricio Burbano, Einar Burbano Burbano","doi":"10.15406/jaccoa.2023.15.00560","DOIUrl":null,"url":null,"abstract":"Purpose: To evaluate the impact of three different effect-site concentrations of remifentanil [1.0, 2.0 and 2.5 ng.ml-1] on cough, heart rate and systolic blood pressure during extubation after balanced anesthesia with desflurane or sevoflurane. Design: Double-blinded controlled trial. Setting: Operating room. Patients: ASA I-II adults (n=451) who underwent elective procedures. Interventions: Subjects were randomly assigned to maintain remifentanil effect-site concentrations at 1.0, 2.0 and 2.5 ng.ml-1 by a target control infusion system after receiving balanced general anesthesia with remifentanil and sevoflurane vs. desflurane. Measurements: Cough severity (using a four-point intensity scale), heart rate and systolic blood pressure were registered during eye opening, tracheal extubation and 2.5 minutes after. Main Results: Cough was significantly reduced in all groups of remifentanil at 2.0 and 2.5 ng.ml-1 during eye opening, tracheal extubation and 2.5 minutes after, when compared with 1.0 ng.ml-1 [Risk ratio (95% CI) at tracheal extubation 0.35 (0.23-0.53) and 0.33 (0.21-0.52) for desflurane; 0.50 (0.35-0.73) and 0.45 (0.30-0.73) for sevoflurane, respectively. P < 0.001]. There were no significant differences on heart rate or systolic blood pressure values at these time points for any of the studied groups. Conclusion: In adult patients of elective procedures under balanced general anesthesia with sevoflurane or desflurane, maintaining a remifentanil effect-site concentration at 2.0-2.5ng.ml-1 significantly reduce the risk of cough but not hemodynamic responses during tracheal extubation.","PeriodicalId":228896,"journal":{"name":"Journal of Anesthesia and Critical Care: Open access","volume":"143 4 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Anesthesia and Critical Care: Open access","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15406/jaccoa.2023.15.00560","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: To evaluate the impact of three different effect-site concentrations of remifentanil [1.0, 2.0 and 2.5 ng.ml-1] on cough, heart rate and systolic blood pressure during extubation after balanced anesthesia with desflurane or sevoflurane. Design: Double-blinded controlled trial. Setting: Operating room. Patients: ASA I-II adults (n=451) who underwent elective procedures. Interventions: Subjects were randomly assigned to maintain remifentanil effect-site concentrations at 1.0, 2.0 and 2.5 ng.ml-1 by a target control infusion system after receiving balanced general anesthesia with remifentanil and sevoflurane vs. desflurane. Measurements: Cough severity (using a four-point intensity scale), heart rate and systolic blood pressure were registered during eye opening, tracheal extubation and 2.5 minutes after. Main Results: Cough was significantly reduced in all groups of remifentanil at 2.0 and 2.5 ng.ml-1 during eye opening, tracheal extubation and 2.5 minutes after, when compared with 1.0 ng.ml-1 [Risk ratio (95% CI) at tracheal extubation 0.35 (0.23-0.53) and 0.33 (0.21-0.52) for desflurane; 0.50 (0.35-0.73) and 0.45 (0.30-0.73) for sevoflurane, respectively. P < 0.001]. There were no significant differences on heart rate or systolic blood pressure values at these time points for any of the studied groups. Conclusion: In adult patients of elective procedures under balanced general anesthesia with sevoflurane or desflurane, maintaining a remifentanil effect-site concentration at 2.0-2.5ng.ml-1 significantly reduce the risk of cough but not hemodynamic responses during tracheal extubation.