• Ying Yao, Cong Yu, Ye Yuan, Guijin Huang, and Sisi Li.
• Department of Anesthesiology, The Affiliated Dental Hospital of Chongqing Medical University, Chongqing, China.
• J Clin Anesth. 2016 Jun 1; 31: 13-8.

Study ObjectiveTo determine the median effective concentration (EC50) of remifentanil during targeted-controlled infusion for smooth tracheal extubation during emergence from total intravenous anesthesia in elderly patients.DesignProspective, Dixon up-and-down method.SettingPostoperative emergence.PatientsTwenty-four American Society of Anesthesiologists grade I-II female elderly patients undergoing elective jaw cyst surgery.InterventionsThe EC50 of remifentanil for smooth emergence was calculated by the Dixon up-and-down method.MeasurementsThe EC50 and 95% confidence intervals were analyzed by probit analysis using logistic regression. Vital signs (mean arterial pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide partial pressure), postanesthesia recovery score, visual analogue pain scale, and adverse effects were monitored. Mean arterial pressure and heart rate were compared between patients with smooth extubation vs those with failed smooth extubation.Main ResultsThe Dixon up-and-down method showed that the EC50 of remifentanil for smooth tracheal extubation during emergency from anesthesia was 0.94 ng/mL in female elderly patients. The probit analysis showed that the EC50 of remifentanil was 0.99 ng/mL (95% confidence interval, 0.52-1.51 ng/mL). Heart rate and mean arterial pressure were significantly lower in patients with smooth extubation as compared with those with failed smooth extubation at 0 minute (at extubation) as well as 1 and 5 minutes after extubation (P< .05).ConclusionsTarget infusion of remifentanil at 0.94 ng/mL could effectively inhibit tracheal extubation-related cough response and cardiovascular responses in 50% of the female elderly patients without delaying recovery from anesthesia, which could ensure smooth tracheal extubation during emergence from anesthesia.Copyright © 2016 Elsevier Inc. All rights reserved.

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