Effect-site concentrations of remifentanil for smooth emergence from combined epidural-general anesthesia or general anesthesia in patients using video double-lumen tube: A randomized trial

Yuxin Li; Siying Li; Ling Jiang; Yiming Liu; Changhong Miao; Chao Liang

doi:10.1016/j.heliyon.2023.e18897

Effect-site concentrations of remifentanil for smooth emergence from combined epidural-general anesthesia or general anesthesia in patients using video double-lumen tube: A randomized trial

Heliyon. 2023 Aug 3;9(8):e18897. doi: 10.1016/j.heliyon.2023.e18897. eCollection 2023 Aug.

Authors

Yuxin Li^{1

2}, Siying Li², Ling Jiang¹, Yiming Liu¹, Changhong Miao^{2

1}, Chao Liang^{2

1}

Affiliations

¹ Department of Anesthesiology, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, People's Republic of China.
² Department of Anesthesiology, Zhongshan Hospital. Fudan University, Shanghai, People's Republic of China.

Abstract

Objective: The present study aimed to determine the effect-site concentration of remifentanil of 90% (EC₉₀) for smooth emergence in patients with a video DLT (VDLT) under sevoflurane-maintained general anesthesia and to investigate whether the EC₉₀ was affected by epidural anesthesia.

Methods: One hundred and twenty patients who underwent video-assisted thoracic surgery (VATS) were enrolled. Patients received either general anesthesia combined with epidural anesthesia (PEA group, n = 60) or general anesthesia (GA group, n = 60). The primary outcome was the EC₉₀ for smooth emergence in both groups. The secondary outcomes were intraoperative emergence, smooth emergence, recovery, and hemodynamic profiles in both groups.

Result: The EC₉₀ values for smooth emergence in patients using VDLT were 3.5 ng/ml (95% confidence interval [CI], 3.3-4.4 ng/ml) in the PEA group and 2.7 ng/ml (95% CI, 2.5-3.2 ng/ml) in the GA group. The total amount of remifentanil infusion during emergency was significantly higher in the PEA group (164.6 ± 47.9 μg) than in the GA group (127.1 ± 30.4 μg) (P < 0.001). The number of patients who experienced hypotension during emergency in the PEA group was higher than that in the GA group (46.7% versus 13.3%, P < 0.001).

Conclusion: The EC₉₀ of remifentanil for smooth emergence in patients with VDLT under general anesthesia combined with epidural anesthesia (3.5 ng/ml) was higher than that under general anesthesia (2.7 ng/ml).

Trial registration: Chinese Clinical Trial Registry, ChiCTR2100054230.

Keywords: Epidural anesthesia; General anesthesia; Remifentanil; Smooth emergence; Target-controlled infusion.