Efficacy of Remifentanil Compared to Lidocaine on the Incidence of Coughing During Emergence of Anesthesia
Condition: Cough; Anesthesia; Extubation
MeSH terms: Cough
Study type: Interventional

Summary: 
      This study is designed to compare the effects of a bolus dose of remifentanil to a bolus dose
      of lidocaine given prior to the emergence of anesthesia:

        -  on the incidence of perioperative coughing

        -  on the time needed for the emergence of a desflurane-based anesthesia

        -  on the incidence of sore throat after extubation.

      Our hypothesis is that the use of a remifentanil bolus dose given prior to emergence of a
      desflurane-based anesthesia will reduce the incidence of perioperative coughing from 70% to
      35% compared to lidocaine.
    

Detailed description: 
      Emergence is an important period of general anesthesia during which several problems can
      occur. Coughing, hypertension, tachycardia and agitation have been observed during emergence
      of general anesthesia.

      Most patients will cough during emergence. Different techniques and drugs have been studied
      to reduce coughing during emergence. Among others, the role of lidocaine given intravenously,
      topically , or intra-cuff has been studied.

      There is some evidence supporting the administration of intravenous opioids prior to
      emergence of general anesthesia to reduce perioperative coughing, agitation and haemodynamic
      stimulation. However, depending on the type of opioids given, this may delay the emergence
      from anesthesia. The effect of a remifentanil infusion given in combination with isoflurane
      as the volatile agent has been shown to reduce the incidence of perioperative coughing
      without delaying the emergence of anesthesia. The effect of a small bolus of remifentanil
      given prior to emergence to prevent perioperative coughing has yet to be studied.

      Desflurane is a newer volatile agent allowing early recovery from anesthesia. This agent has
      led to earlier discharge and more rapid resumption of normal activities after surgery.
      However, an incidence of coughing around 70% has been reported after a desflurane-based
      anesthesia.

      This study will compare the effects of remifentanil (bolus dose of 0.25 mcg/kg or 0.5 mcg/kg)
      to lidocaine (bolus dose of 1mg/kg) when given prior to emergence to prevent perioperative
      coughing after a desflurane-based anesthesia.

      Methods:

        -  Induction of general anesthesia: 1.5-3 mg/kg propofol and 1-3 mcg/kg fentanyl.
           Neuromuscular relaxation at the discretion of the attending anesthesiologist.

        -  Tracheal intubation using direct laryngoscopy.

        -  Maintenance of general anesthesia: desflurane between 0.7 and 1.0 MAC, fentanyl 1
           mcg/kg. Neuromuscular relaxation will be carried out at the discretion of the attending
           anesthesiologist.

        -  No opioids should be given during the last 30 minutes of surgery.

        -  Reversal of neuromuscular blockade is mandatory at the end of surgery.

        -  At the end of surgery : discontinuation of desflurane.

        -  Administration of the study drug: (bolus dose of remifentanil 0.25 mcg/kg, remifentanil
           0.5 mcg/kg or lidocaine 1 mg/kg).

        -  When the expired fraction of desflurane reaches 0.2 MAC, the patient will be asked to
           open his eyes every 30 seconds.

        -  After eyes opening, ventilator will be stopped and the extubation performed.

        -  Number of coughing episodes and their importance will be rated on a scale from 0 to 3 by
           a blinded observer during emergence and the first ten minutes after extubation.

        -  Time elapsed between the administration of the bolus dose of the study drug to
           extubation will be recorded.

        -  The presence of sore throat will be assessed one hour after extubation.
    

Intervention name(s): Remifentanil; Remifentanil; lidocaine
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Bolus dose of intravenous remifentanil 0,25 mcg/kg given once before emergence of general anesthesia.; Bolus dose of intravenous remifentanil 0.5 mck/kg given once before emergence of general anesthesia.; Bolus dose of intravenous remifentanil 0.5 mck/kg given once before emergence of general anesthesia.
Intervention MeSH terms: Lidocaine; Remifentanil
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention