The Effect Of Maintaining A Remifentanil Infusion On Smooth Recovery During Emergence From General Anesthesia:A META-analysis

OBJECTIVE: Providing a Meta-analysis to evaluate the preventive effect of remifentanil on cough and hemodynamic fluctuations during emergence from general anesthesia.METHODS: Designing search strategies,articles in Chinese or English published in PubMed,EMBASE,The Cochrane Library,Chinese Biomedical Literature Database,Wanfang Database,and China journals Full-Text Database were searched up to September 2017.All randomized controlled trials(RCTs)for remifentanil to prevent coughing during emergence from general anesthesia were included and estimated qualities by the Cochrane handbook.The RevMan5.3 software was used for meta-analysis.Date from studies were combined using the relative risk(RR),weighted mean difference(WMD)and their associated 95% confidence intervals(CI).P<0.1and I2>50% were used to indicate heterogeneity.RESULTS: Twelve RCTs were eventually included,including 705 patients.Meta analysis results were showed below1.Primary outcome:Cough incidence: The remifentanil incidence of cough [RR=0.58,95% CI(0.49,0.69)P<0.00001].There was no significant difference between remifentanil group and dexmedetomidine group [RR=0.35,95%CI(0.05,2.57)P=0.30].Deleterious cough incidence: The remifentanil lowered incidence of deleterious cough(RR=0.24,95% CI(0.13,0.45)P<0.00001).There was no significant difference between remifentanil group and dexmedetomidine group [RR=0.48,95% CI(0.22,1.01)P=0.05].2.Secondary outcome:Extubation time: There was no significant difference between remifentanil group and control group [MD=0.34,95% CI(–0.55,1.23),P=0.46]PONV incidence: There was no statistically significant difference in the incidence of PONVbetween remifentanil group and control group.[RR=1.03,95% CI(0.47,2.29),P=0.93]Heart rate: 1 At extubation,the HR was lower in remifentanil group than [MD =-11.86,95%CI(-17.83,-5.90)P < 0.00001].2 At 5 min after extubation,the HR was lower in remifentanil group [MD =-7.04,95% CI(-12.33,-5.20)P = 0.99].Mean arterial pressure(MAP): 1 At extubation,the MAP was lower in remifentanil group[MD =-12.72,95% CI(-19.14,-6.30)P = 0.0001].2 At 5 min after extubation,there was no significant difference between remifentanil group and control group [MD=-4.61,95% CI(-10.03,0.82)P=0.10].CONCLUSION: The available evidence showed that maintaining an intravenous infusion of remifentanil during emergence from general anesthesia could decrease the incidence of cough and deleterious cough,without prolonging the extubation time or increasing the incidence of POVN.Remifentanil was beneficial to the stability of hemodynamics,and the effect of preventing cough was not better than dexmedetomidine.However,considering the inconsistencies design and quality the included studies,the above conclusions should be verified by more high-qualityRCTs.