Pretreatment With Remifentanil Prevents Cough Induced By Sufentanil During Induction Of General Anesthesia

Object:Intravenous injection of sufentanil during the induction period of general anesthesia often causes coughing reactions.In this study,pretreatment with 0.5μg/kg remifentanil was used to observe its inhibitory effect on sufentanil-induced coughing before the induction of general anesthesia.Provide a certain theoretical basis for the rational use of drugs in clinical anesthesia.Method:A total of 120 patients who were selected for elective surgery under general anesthesia at the Second Affiliated Hospital of Nanchang University from September2020 to February 2021 were selected.The American Association of Anesthesiologists（ASA）grade I-II,age 18-60 years old,weight 45-80kg,regardless of gender.Exclusion criteria:abnormal renal or liver function;history of cardiovascular and cerebrovascular diseases;history of asthma;history of chronic cough;history of smoking;opioids received 2 weeks before surgery;history of upper respiratory tract infection 2 weeks before surgery;Patients receiving angiotensin-converting enzyme inhibitors,bronchodilators,or steroids 2 weeks before surgery.The patients were randomly divided into two groups using a computerized random number table:R group（0.5μg/kg remifentanil group）and N group（normal saline control group）four groups,each with 60 cases.After entering the room,routine electrocardiogram（ECG）,pulse oximetry（Sp O₂）,blood pressure（BP）and heart rate（HR）were monitored,and upper limb venous access was established.Ringer lactate was infused at a rate of4-6ml/min.One minute before induction of anesthesia,the R group was given remifentanil 0.5μg/kg（diluted to 5ml）for pretreatment,and the injection was completed within 5s;the N group was given 5ml of normal saline and the injection was completed within 5s.Sufentanil（0.5μg/kg）was injected intravenously after 1min of pretreatment,and the injection was completed within 5 seconds,followed by sequential injections of midazolam（0.04mg/kg）,etomidate（0.3mg/kg）,Rocuronium bromide（0.6mg/kg）and other anesthesia-inducing drugs,after the muscle relaxation is satisfied,the tracheal intubation is performed with a visual laryngoscope.Record the mean arterial pressure（MAP）of the two groups before injection of remifentanil or saline（T1）,before injection of sufentanil（T2）,before tracheal intubation（T3）and after tracheal intubation（T4）,Pulse oxygen saturation（Sp O₂）and heart rate（HR）.The number,frequency and degree of coughing in the two groups were recorded.The degree of choking is graded according to the number of times of coughing.No choking:0 times;mild:1-2 times;moderate:3-5 times;severe:>5 times.In addition,other adverse events such as dizziness,nausea,apnea,trunk stiffness and bradycardia were also recorded.Result:There were no significant differences in age,height,weight,BMI,gender and ASA classification between the two groups（P>0.05）.The incidence of SIC in group R was significantly lower than that in group N（5.0%vs.35.0%）,and the difference was statistically significant（P<0.001）.Among patients with SIC,the number of severe coughing in group R was significantly lower than that in group N,and the difference was statistically significant（P<0.01）.There were no significant differences in MAP,HR and Sp O₂ between the two groups of patients at T1,T2,T3 and T4.One patient in the N group developed chest wall stiffness during induction of general anesthesia,and two patients in the R group developed transient light dizziness after pretreatment with remifentanil.Conclusion:Pretreatment with 0.5μg/kg remifentanil 1 min before induction of general anesthesia can effectively inhibit the cough response induced by intravenous injection of 0.5μg/kg sufentanil within 5s,and reduce the severity of cough to a certain extent.At the same time,it will not cause hemodynamic fluctuations during the induction period of general anesthesia.