The Median Effective Dose Value Of Remifentanil In Inhibiting Cough Response During Extubation In Children With Obstructive Sleep Apnea Syndrome

Objective: To investigate the median effective dose(ED50)value of constant rate infusion of remifentanil in inhibiting cough response during extubation in children with OSAS(Obstructive Sleep Apnea Syndrome).Methods: Fifty-one children who underwent tonsillectomy(with or without adenoidectomy)at the Affiliated Hospital of Inner Mongolia Medical University from December 2019 to May 2020 were selected.The ASA(American Society of Anesthesiologists)physical status was classified asⅠ.Dixon upper and lower sequential method was used to determine the ED50 of remifentanil,the initial rate of remifentanil infusion at constant rate was 0.06ug/kg/min,and the difference between two remifentanil infusion rates was 0.01ug/kg/min;If no cough occurred in the extubation period,it was defined as no cough,and the infusion rate of the next child was reduced by 0.01ug/kg/min.If cough persisted during extubation,it was defined as cough.The infusion rate of the next child was increased by 0.01ug/kg/min until 7groups of alternating positive and negative waves appeared,and the experiment was terminated.The median effective dose(ED50)and 95% confidence intreval(CI)of remifentanil in inhibiting extubation response in children was calculated by Probit probability regression analysis.According to the manifestations of cough reaction,the children were divided into cough group and non-cough group.The extubation time,recovery time,restlessness and respiratory complications after extubation were recorded and compared in each group.Results:(1)The ED50 of constant rate infusion of remifentanil was0.042ug/kg/min(95%CI was 0.025-0.062ug/kg/min)in inhibiting cough reaction after extubation in children with OSAS.(2)There were no significant differences in age,sex,weight and operation time between the two groups(P>0.05).(3)The total remifentanil dosage and remifentanil infusion rate in the non-cough group were higher than those in the cough group,and the differences were statistically significant(P<0.05).However,there was no significant difference in extubation time and recovery time between the two groups(P>0.05).(4)There was no correlation between remifentanil infusion concentration and extubation time and recovery time in the non-cough group,r values are 0.13 and 0.12,and P>0.05.(5)There were no postoperative complications related to respiratory system between the two groups,and the difference was not statistically significant(P>0.05).Conclusion: The ED50 value of constant rate infusion of remifentanil was0.042ug/kg/min to inhibit the cough response during extubation in the children with OSAS.Small dose infusion of remifentanil did not affect the time of recovery and extubation.