WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Dr. Natiq D. Shalaan*

ABSTRACT

Background: Emergence from general anesthesia can be associated with coughing, agitation, hypertension, and tachycardia, which may cause bleeding from the surgical site, and an increase in intracranial and intraocular pressure. In addition to respiratory complications, hemodynamic complications such as hypertension, increasing intraocular and intracranial pressure, tachycardia, and dysrhythmia can occur with extubation that can be hazardous in high-risk patients. Remifentanil is an opioid with instant effect and rapid elimination that is not influenced by age or the functions of the liver and kidneys, and does not result in delayed recovery or respiratory depression after a continuous infusion and recently it has been recommended as a promising agent in attenuating hemodynamic and respiratory complications of anesthesia. Patients and Methods: This prospective clinical trial, case control study, Including one hundred twenty adult patients undergoing lower abdomen, orthopedics or plastic surgery. All patients received a standard general anesthesia. At the end of surgery, Group A received a bolus dose of remifentanil 0.5 microgram/kilogram (N = forty), Group B received 1microgram/kilogram remifentanil (N= forty) and Group C received placebo (normal saline) (N = forty), when extubation criteria were achieved non- invasive arterial pressure, heart rate and oxygen saturation were measured 1minute before extubation, remifentanil was given over 30 seconds, and tracheal extubation was performed. Non-invasive arterial pressure, heart rate and oxygen saturation also measured 1minute intervals after extubation to fifth minute. Results: One hundred twenty patients enrolled the study. 73 of them were male and 47 female, age of 27.47 ± 5.96 years, weight of 75.57 ± 7.96 kg. Patients who developed apnea after endotracheal extubation are (18.33%), 5% of group A and 50% of group B while none of the group C, and P – value was very significant (0.0001). Were no statistically significant associations between different study groups and both of age and weight of the patients, P – values were not significant and more than 0.05. Except for 1 minute before extubation there was statistically significant association between the different study groups and SBP,DBP,MAP and HR readings before and after extubation follow ups. In all conditions patients from group C had the highest SBP, DBP, MAP and HR readings followed by group A then group B, P – value was significant and less than 0.05. There was no statistically significant association between study groups and SaO2, P – values were higher than 0.05. Conclusions: Patients receiving remifentanil are hemodynamically stable during and after endotracheal extubation in compare with patients receiving normal saline. Patients receiving remifentanil 0.5mcg/kg, hemodynamic measures more close to normal values and less incidence of apnea than patients whose receiving remifentanil 1mcg/kg. No difference in oxygen saturation and no significant associations between different study groups and both of age and weight of the patients among three groups.