Anesthesia
Conditions
Keywords
Thyroidectomy, Remifentanil, Extubation, Cough, Target controlled infusion
Brief summary
The study is aimed at determining the remifentanil effect site concentration suppressing the cough at extubation after surgical thyroidectomy, performed under remifentanil/desflurane based general anesthesia, expressed as median and 95th percentile effective dose. Possible hemodynamic instability, respiratory depression or prolongation of awakening time are also sought.
Interventions
OTHERRemifentanil Effect site concentration
After skin suture, a predetermined Effect site remifentanil concentration will be achieved. Starting from 1.5 ng/ml in the first patient and increased or decreased by 0.2 ng/ml intervals based on the previous patient response: up if cough present, down otherwise (Dixon's up and down method).
Sponsors
University of Cagliari
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
OTHER
Masking
NONE
Masking description
Patient under general anesthesia unaware of the effect site concentration of remifentanil before extubation
Intervention model description
Prospective observational study. Decreasing/increasing remifentanil effect site concentrations (Dixon's up and down model) to obtain cough-free extubation after thyroidectomy
Eligibility
Sex/Gender
ALL
Age
18 Years to 67 Years
Healthy volunteers
No
Inclusion criteria
* 18\<age\<67 * 6 hrs fasting * American society of anesthesiology (ASA) Physical Status I o II * Informed consent
Exclusion criteria
* Absence of inclusion criteria * Use of cough suppressors, angiotensin converting enzyme-inhibitors, sedatives 4 weeks before surgery * Arhythmia, pacemaker or unstable cardiovascular disease * Hepatic or renal failure * Anticipated difficulty in airways management * Chronic obstructive pulmonary disease (COPD), Asthma, increased risk for inhalation, airway infection in the previous 4 weeks; * Smoker * Obesity (BMI \>35) * Pregnancy * Hypersensitivity to drugs administered for the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cough | 15 minutes after surgery | Any episode of sudden and violent abdominal contraction interrupting normal quite spontaneous or assisted ventilation would be accounted as cough and defines non-smooth extubation |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamics 1 | 15 minutes after surgery | Heart Rate (bpm) |
| Hemodynamics 2 | 15 minutes after surgery | Blood pressure (mmHg) |
| Respiratory outcome 1 | 15 minutes after surgery | Tidal Volume (ml) |
| Respiratory outcome 2 | 15 minutes after surgery | End Tidal Carbon Dioxide (mmHg) |
Countries
Italy
Contacts
Primary ContactPaolo Onida, MD
Backup ContactPaolo Mura, MD
Outcome results
None listed