Does Precise Delivery of Remifentanil Decrease Coughing at Emergence From Anesthesia

Study Overview
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Brief Summary
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The investigators want to find a way to reduce or stop patients from coughing at the end of surgery when the breathing tube is taken out. The breathing tube is removed when the participants are waking up from anesthesia, and are at the point when the participants can breathe on your own. In most types of surgery, coughing at this point is common, and does not affect the participants very much, if at all. But for surgery involving the eye or the head and neck, coughing right after surgery can cause bleeding at the site of surgery. This study will use a short-acting pain drug called remifentanil at the end of surgery to prevent coughing. The investigators will give the participants this medicine for 5 to 30 minutes. The point of the study is to test if using a simple computer program to guide precise delivery of how much of the drug is given to the participants is effective at reducing or preventing coughing.

Official Title
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Does Precise Delivery of Remifentanil Decrease Coughing at Emergence From Anesthesia

Conditions
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Cough

Intervention / Treatment
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* Drug: Remifentanil
* Drug: Normal saline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between the ages of 18 and 80 ASA of 1-3 Undergoing any of the following elective cases: thyroidectomy (partial or complete) parathyroidectomy ophthalmological surgery Will require endotracheal intubation. Exclusion Criteria: Lean Body Mass < 20 kg, BMI > 45 Presence of pulmonary dysfunction Any history of anaphylaxis to remifentanil Requiring the use of total intravenous anesthesia. Per the discretion of the anesthesia provider

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Remifentanil group<br>Will receive remifentanil bolus and infusion guided by an algorithm | Drug: Remifentanil<br>* Receive remifentanil bolus and infusion guided by an algorithm.<br>|
| Placebo Comparator: Control group<br>Will receive normal saline bolus and infusion guided by the remifentanil algorithm | Drug: Normal saline<br>* Receive normal saline bolus and infusion guided by the remifentanil algorithm.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of cough | Notes presence of cough during emergence | Measured from surgical end time to patient transfer out of room, approximetly 30 minutes and up to 45 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Coughing grade | Ranks severity of cough during emergence: cough was graded according to the following scoring guidelines: 0=no cough, 1=slight cough, cough without obvious contraction of the abdomen, 2=moderate cough, strong and sudden contraction of the abdomen lasting for less than 5 seconds and 3=severe cough, strong and sudden contraction of the abdomen sustained for more than 5 seconds. | Measured from surgical end time to patient transfer out of room, approximetly 30 minutes | 
| Extubation time | Time between the termination of the anesthetic and extubation | Measured from termination of the anesthetic to extubation, approximetly 5 minutes and up to 30 minutes | 
| Time to recovery | Time between extubation and the ability to perform purposeful movement | Measured from extubation to purposeful movement, approximetly 5 minutes and up to 30 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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extubation