The effect of remifentanil on cough suppression after endoscopic sinus surgery: a randomized study

Excessive coughing may increase the risk of complications after sinus surgery. We hypothesized that remifentanil would decrease the incidence and severity of coughing after endoscopic sinus surgery with propofol and remifentanil anaesthesia.

Ninety patients scheduled for endoscopic sinus surgery were randomly assigned into three groups. Propofol was stopped at the completion of the surgical procedure. The remifentanil infusion was adjusted to an effect-site concentration of 1.5, 2.0 or 2.5 ng/ml, 10 min before the anticipated end of surgery, in each of the three groups (RF₁(.)₅, RF₂(.)₀ and RF₂(.)₅) and continued until after extubation. The incidence and severity of coughing was evaluated on a scale from 0 to 3.

The proportion of patients who did not cough was significantly higher in the RF₂(.)₀ (67.5%, 95% CI: 59.1– 75.9%) and RF₂(.)₅ (74.2%, 95% CI: 66.4–82.0%) groups than in the RF₁(.)₅ group (35.%, 95% CI: 26.5–43.5%) (P < 0.01). The incidence of grade 2 or 3 coughing was significantly higher in the RF₁(.)₅ group (grade 2: 15.1%, grade 3: 6.7%) than in the RF₂(.)₀ group (grade 2: 5.0%, grade 3: 0%) and the RF₂(.)₅ group (grade 2: 4.2%, grade 3: 0%) (P < 0.05). There was no statistically significant difference in the time to extubation among the three groups.

Maintaining anaesthesia with remifentanil to the end of the surgery, until after extubation, can suppress coughing without prolonging the recovery from anaesthesia. This effect is dose dependent and is more pronounced at higher concentrations of remifentanil (2.0 or 2.5 ng/ml).