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Sex differences in remifentanil requirements for preventing cough during anesthetic emergence.

ABSTRACT: Target-controlled infusion (TCI) of remifentanil can suppress coughing during emergence from general anesthesia; nevertheless, previous studies under different clinical conditions recommend significantly different effective effect-site concentrations (effective Ce) of remifentanil for 50% of patients (EC??). The differences among these studies include type of surgery and patient sex. In recent years, study of sex differences in regards to anesthetic pharmacology has drawn greater interest. Accordingly, we attempted to determine the effective Ce of remifentanil for preventing cough for each sex under the same clinical conditions.Twenty female and 25 male ASA physical status I-II grade patients between the ages of 20 and 46 years who were undergoing thyroidectomy were enrolled in this study. The effective Ce of remifentanil for preventing cough was determined for each sex using the isotonic regression method with a bootstrapping approach, following Dixon's up-and-down method.Isotonic regression with a bootstrapping approach revealed that the estimated EC?? of remifentanil for preventing coughing during emergence was significantly lower in females {1.30 ng/mL [83% confidence interval (CI), 1.20-1.47 ng/mL]} than in males [2.57 ng/mL (83% CI, 2.45-2.70 ng/mL)]. Mean EC?? in females was also significantly lower than in males (1.23±0.21 ng/mL vs. 2.43±0.21 ng/mL, p<0.001). Mean arterial pressure, heart rate, and respiratory rate over time were not significantly different between the sexes.When using remifentanil TCI for cough prevention during anesthetic emergence, patient sex should be a considered for appropriate dosing.

SUBMITTER: Soh S

PROVIDER: S-EPMC3990090 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

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Sex differences in remifentanil requirements for preventing cough during anesthetic emergence.

Soh Sarah S Park Wyun Kon WK Kang Sang Wook SW Lee Bo Ra BR Lee Jeong Rim JR

Yonsei medical journal 20140401 3

<h4>Purpose</h4>Target-controlled infusion (TCI) of remifentanil can suppress coughing during emergence from general anesthesia; nevertheless, previous studies under different clinical conditions recommend significantly different effective effect-site concentrations (effective Ce) of remifentanil for 50% of patients (EC₅₀). The differences among these studies include type of surgery and patient sex. In recent years, study of sex differences in regards to anesthetic pharmacology has drawn greater ...[more]

PMID: 24719152

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Project description:Sevoflurane is commonly usedin pediatric anesthesia due to its non-irritating airway properties, and rapid induction and emergence. However, it is associated with emergence agitation (EA) in children. EA may cause injury to the child or damage to the surgical site and is a cause of stress to both caregivers and families. The efficacy of remifentanil and additional alfentanil on EA in the pediatric patients underwent ophthalmic surgery with sevofluraneanesthesiawas not well evaluated to date. This study was designed to compare the effects of remifentanil and remifentanil plus alfentanil on EA in children undergoing ophthalmic surgery with sevofluraneanesthesia.Children (aged 3-9 years) undergoing ophthalmic surgery undersevoflurane anesthesia were randomly assigned to group S (sevoflurane alone), group R (sevofluraneandremifentanil infusion, 0.1 ?g/kg/min), or group RA (sevoflurane withremifentanil infusion and intravenous injection of alfentanil 5 ?g/kg 10 min before the end of surgery). Mean arterial pressure (MAP), heart rate (HR), and sevoflurane concentration were checked every 15 min after induction of anesthesia. The incidence of EA, time to extubation from discontinuation of sevoflurane inhalation, and time to discharge from the postanesthesia care unit was assessed.The incidence of EA was significantly lower in groups R (32 %, 11/34; P?=?0.01) and RA (31 %, 11/35; P?=?0.008) than group S (64 %, 21/33). The time to extubation was prolonged in group RA (11.2?±?2.3 min; P?=?0.004 and P?=?0.016) compared with groups S (9.2?±?2.3 min) andR (9.5?±?2.4 min). MAP and HR were similar in all three groups, apart from a reduction in HR at 45 min in groups R and RA. However, the sevoflurane concentration was lower in groups R and RA than group S (P?<?0.001).The administration of remifentanil to children undergoing ophthalmic surgery undersevoflurane anesthesia reduced the incidence of EA without clinically significant hemodynamic changes. However, the addition of alfentanil(5 ?g/kg)10 min before the end of surgery provided no additional benefit compared withremifentanil alone.NCT02486926 , June.29.2015.

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Sex differences in remifentanil requirements for preventing cough during anesthetic emergence.

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Sex differences in remifentanil requirements for preventing cough during anesthetic emergence.

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