Clinical Study Of The Effects Of Different Doses Of Remifentanil And Tramadol On Attenuating The Responses To Tracheal Extubation

Objective: To investigate the effects of different doses of remifentanil or tramadol for preventing cardiovascular responses to tracheal extubation undergoing oral and maxillofacial surgery,and to observe the proper dose of remifentanil for this purpose.Methods: Eighty ASA physical status I～II patients,aged 18～60 year undergoing elective oral and maxillofacial surgery were randomly allocated to four groups(n=20 each): before tracheal extubation,different drugs were administrated , groupâ… (Remifentanil 0.5ug/kg) , groupâ…¡(Remifentanil 1ug/kg) , groupâ…¢(Tramadol 100mg) , groupâ…£(0.9% Sodium chloride injection 5 ml). SBP,DBP,HR and RPP were measured and recorded before operation(T₀),just before administration(T₁),2 min after administration (T₂), suction(T₃),extubation (T₄),1min after extubation (T₅),5min after extubation (T₆),10min after extubation(T₇),the time of extubation and side-effects such as coughing,agitation,glossocoma,sleepiless and respiratory depression were recorded.Results: Compared with baseline values,increases in SBP,DBP,HR, RPP occurred during emergence and tracheal extubation in groupâ…£(P<0.05),there are no significant increases in SBP,DBP,HR in groupâ… ,â…¡andâ…¢. SBP,DBP,HR and RPP values were significantly higher in groupâ…£compared with groupâ… ,â…¡andâ…¢during emergence and tracheal extubation(P<0.05). SBP,DBP,HR and RPP at T₂ were lower than that at T₁ in groupâ… andâ…¡(P<0.05),HR at T₂ were lower than that at T₁ in groupâ…¢(P<0.05). SBP,DBP,HR and RPP at T₂ in groupâ… ,â…¢,â…£were higher than that in groupâ…¡(P<0.05). The occurrence of coughing and agitation was significantly lower in groupâ… ,â…¡andâ…¢compared with groupâ…£(P<0.05),the occurrence of glossocoma ,sleepiless after extubation was higher in groupâ…¡than that in groupâ…£(P<0.05),the occurrence of glossocoma after extubation was higher in groupâ… than that in groupâ…£(P<0.05).Conclusion: Remifentanil 0.5ug/kg and Tramadol 100mg intravenous infusion can reduce haemodynamic changes and coughing associated with tracheal extubation almost without significantly delaying recovery from anaesthesia. It is particularly valuable to the elderly and patients with cardiovascular disease.