Sevoflurane in combination with remifentanil for tracheal extubation after otologic surgery.

PURPOSE: The effects of i.v. remifentanil in combination with an inhaled anesthetic to facilitate tracheal extubation of deeply anesthetized adults after otologic surgery are investigated.

METHODS: Fifty patients undergoing middleear surgery were recruited for the study. All patients were administered deep anesthesia (i.v. fentanil, propofol, and mivacurium) and intubated, with subsequent administration of inhaled sevoflurane for anesthesia maintenance. Prior to endotracheal tube removal, the patients received i.v. dexamethasone, ondansetron hydrochloride, and parecoxib and were randomly allocated to two groups. In group S (n = 25), anesthesia was maintained with sevoflurane alone (1.3 times the minimum effective alveolar concentration [MAC]), while patients in group SR (n = 25) received low-dose i.v. remifentanil and a reduced dose of sevoflurane (1.0 MAC).

RESULTS: The mean remifentanil dosage was 0.028 μg/kg per minute. Relative to patients in group S, patients in group SR had a significantly lower mean respiratory rate (6.4 breaths per minute versus 15.8 breaths per minute, p < 0.01) and end-tidal carbon dioxide pressure (48.1 mm Hg versus 52.1 mm Hg, p < 0.05) after extubation. Postextubation airway obstructions requiring nasal airway placement were less frequent in group SR (14 cases versus 2 cases in group S, p < 0.05); patients in group SR also had a shorter mean time to awakening (19.5 minutes versus 15.8 minutes, p < 0.05) and a shorter mean time to orientation (31.4 minutes versus 26.1 minutes, p < 0.05).

CONCLUSION: Sevoflurane combined with remifentanil provided rapid recovery and appeared to be safe for deep-anesthesia tracheal extubation in adult patients after otologic surgery.