Dataset Information

Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position.

ABSTRACT:

Background

A sore throat is an adverse postoperative consequence of tracheal intubation under general anesthesia. Recently, dexmedetomidine, an anesthetic adjuvant, has shown beneficial effects in postoperative sore throat (POST). Herein, we compared the effects of dexmedetomidine and remifentanil on POST after spinal surgery in the prone position, which is a risk factor for developing POST.

Methods

Ninety-eight patients were enrolled in the dexmedetomidine and remifentanil groups. Each drug was continuously infused using the following protocol: 1 μg/kg over 10 minutes followed by 0.2 to 0.8 μg/kg/h of dexmedetomidine, 3 to 4 ng/mL during induction followed by 1 to 3 ng/mL of remifentanil intraoperatively. The incidence and severity of POST were assessed serially at 24 hours postoperatively. Postoperative hoarseness, nausea, and pain scores were measured.

Results

The incidence and severity of POST were significantly lower in the dexmedetomidine group than that in the remifentanil group. However, the incidence of hoarseness was comparable between the 2 groups. Postoperative nausea was lower in the dexmedetomidine group at 1 hour postoperatively; however, the postoperative pain score and analgesic requirements did not differ significantly.

Conclusions

Dexmedetomidine infusion as an adjuvant during sevoflurane anesthesia significantly reduced the incidence and severity of POST in patients who underwent lumbar surgery 24 hours postoperatively.

SUBMITTER: Choi EK

PROVIDER: S-EPMC10082256 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Publications

Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position.

Choi Eun Kyung EK Baek Jongyoon J Kim Do Young DY

Medicine 20230401 14

<h4>Background</h4>A sore throat is an adverse postoperative consequence of tracheal intubation under general anesthesia. Recently, dexmedetomidine, an anesthetic adjuvant, has shown beneficial effects in postoperative sore throat (POST). Herein, we compared the effects of dexmedetomidine and remifentanil on POST after spinal surgery in the prone position, which is a risk factor for developing POST.<h4>Methods</h4>Ninety-eight patients were enrolled in the dexmedetomidine and remifentanil groups ...[more]

PMID: 37026907

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Project description:IntroductionPostoperative sore throat is the most frequently complaint after tracheal intubation. We aimed to determine whether changing patients' head position during intubation reduces the incidence of postoperative sore throat.MethodsWe randomized 130 patients receiving oral tracheal intubation into one of the two groups: the sniffing position group and elevation position group. Patients in the sniffing position group maintained sniffing position consistently during intubation, while those in the elevation position group transitioned from the sniffing position to the elevation position during tube advancement to the trachea. The primary outcome was incidence of airway trauma and postoperative sore throat (none/mild/moderate/severe) 1 h after surgery. The secondary outcomes were the incidence of postoperative sore throat at 6 h,12 h and 24 h, and hoarseness at 1 h, 6 h,12 h and 24 h postoperatively.ResultsOne hundred twenty-eight patients completed our trial. There were no differences in the baseline characteristics of the patients between the sniffing position and elevation position group [51 (14.8) vs 53 (15.5) for age, 25/39 vs 26/38 for sex (male/female)]. No difference in basic airway condition was observed. Transitioning patient's head from sniffing to elevation position during tube advancement to tracheal resulted in a significantly lower incidence of airway trauma [10/64 vs 23/64, risk ratio (95% CI): 0.76 (0.61-0.94), p = 0.009], postoperative sore throat and hoarseness compared with maintaining the sniffing position at 1 h [10/64 vs 30/64, risk ratio (95% CI): 0.63 (0.49-0.81), p < 0.001 for sore throat; 22/64 vs 34/64, risk ratio (95% CI): 0.71 (0.52-0.98), p = 0.044 for hoarseness] and 6 h [4/64 vs 17/64, risk ratio (95% CI): 0.78 (0.67-0.92), p = 0.006 for sore throat; 12/64 vs 27/64, risk ratio (95% CI): 0.71 (0.56-0.91), p = 0.002 for hoarseness]. There were no significant differences in postoperative sore throat and hoarseness at 12 and 24 h between the two groups.ConclusionsTransitioning patients' head position from the sniffing position to a head elevation position during tube advancement into tracheal could significantly reduce the incidence of airway trauma, postoperative sore throat and hoarseness.Trial registration numberChiCTR2300073198.

Project description:Background: Combination of dexmedetomidine and opioid may be an alternative to high-dose opioid in attenuating cough during emergence from anesthesia, while also reducing the adverse effects of high-dose opioid. We tested the hypothesis that a single-dose of dexmedetomidine combined with low-dose remifentanil infusion during emergence would not be inferior to high-dose remifentanil infusion alone in attenuating cough after thyroidectomy. Methods: One hundred sixty-nine patients undergoing thyroidectomy were enrolled and randomized in a 1:1 ratio into group DR or group R. Each patient received an infusion of dexmedetomidine (0.5 μg/kg) and low-dose remifentanil infusion of effect-site concentration (Ce) at 1 ng/mL or normal saline and high-dose remifentanil infusion of Ce at 2 ng/mL for 10 min at the end of surgery. Remifentanil was maintained until tracheal extubation. Primary endpoint was the severity of coughing, which was assessed for non-inferiority using a four-point scale at the time of extubation. For comparison of coughing incidence during emergence, coughing grade was also measured at three times: before extubation, at extubation, and after extubation. Time to awakening, hemodynamic and respiratory profile, pain, and postoperative nausea and vomiting were also evaluated for superiority. Results: The 95% confidence intervals for differences in cough grade during tracheal extubation were <0.9, indicating non-inferiority of the single dose of dexmedetomidine combined with low-dose remifentanil infusion. The incidence of coughing was similar in the two groups. Hemodynamic changes during tracheal extubation were attenuated, but emergence from anesthesia was delayed, in group DR. Use of rescue antiemetic was similar in both groups, but the incidence of vomiting was less in group DR. Conclusion: A single-dose of dexmedetomidine (0.5 μg/kg) combined with low-dose remifentanil infusion at 1 ng/mL of Ce during emergence from sevoflurane-remifentanil anesthesia was not inferior to high-dose remifentanil infusion alone at 2 ng/mL of Ce with regard to suppressing cough.

Dataset Information

Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position.

Background

Methods

Results

Conclusions

Publications

Effect of dexmedetomidine and remifentanil infusion on postoperative sore throat after lumbar spine surgery in the prone position.

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