OBJECTIVETo explore the efficacy and safety of small-dose remifentanil for attenuating cardiovascular response to tracheal extubation after surgery with general anesthesia.

METHODSA total of 164 patients scheduled for upper abdominal operation were randomized into groups A (n=41), B (n=43), C (n=40) and D (n=40). In groups A, B, and C, the patients received continuous infusion of remifentanil at the doses of 0.05, 0.10 and 0.20 µg·kg(-1)·min(-1), respectively, while those in group D were not given any drug before tracheal extubation. The change of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded before induction of anesthesia (T1), at the time of extubation (T2), and at 1 min (T3), 3 min (T4), and 5 min (T5) after extubation. The recovery time and adverse effect of extubation were recorded.

RESULTSIn each group, SBP, DBP and HR at T2 and T3 were significantly higher than those at T1 (P<0.05). SBP, DBP and HR were significantly higher in groups A, B and C than in group D (P<0.05), and significantly higher in groups A and B than in group C. The time of spontaneous breath recovery and awaking showed no significant difference in the 4 groups (P>0.05). The rates of adverse effect (nausea and vomiting) in groups A and B were significantly lower than that in group C (P<0.05), but comparable between groups A and B (P>0.05).

CONCLUSIONSRemifentanil at the optimal dose of 0.10 µg·kg(-1)·min(-1) can effectively prevent cardiovascular response to tracheal extubation and reduce the adverse effect associated with anesthesia without prolonging the recovery time.