The Effect of Low-Dose Remifentanil on Responses to the Endotracheal Tube During Emergence from General Anesthesia

In Brief BACKGROUND: Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. METHODS: In a prospective, double-blind, randomized trial, we enrolled 60 adult patients undergoing nasal surgery using remifentanil-based anesthesia. During the emergence phase, the remifentanil group had remifentanil reduced to one tenth of the maintenance rate, whereas the control group had remifentanil discontinued. RESULTS: Times to awakening and tracheal extubation were similar between the two groups. During emergence, the remifentanil group (infusion rate 0.014 ± 0.011 μg · kg−1 · min−1) had a significantly lower incidence (40% vs 80%, P = 0.002) and less severe coughing compared with the control group, as well as a lower incidence of nonpurposeful movement (3.3% vs 30%, P = 0.006) and slower heart rates. CONCLUSIONS: Low-dose remifentanil during emergence did not prolong wake-up but reduced the incidence and severity of coughing from the endotracheal tube. IMPLICATIONS: This prospective, randomized, double-blind study evaluated the effect of low-dose remifentanil on responses to the endotracheal tube during emergence from general anesthesia. Patients who received low-dose remifentanil during emergence had a lower incidence of cough, nonpurposeful movement, and tachycardia compared with patients who had remifentanil stopped during emergence.