The influence of high-dose intraoperative remifentanil on postoperative sore throat

Abstract

Background: Endotracheal intubation for general anesthesia causes postoperative sore throat (POST). This study is designed to evaluate the effect of high-dose remifentanil on the incidence of POST in patients after general anesthesia. Methods:Ninety-two patients scheduled for orthopedic lower extremity surgery under general anesthesia were randomly assigned into 1 of 2 groups. In the high-dose remifentanil (HR) group (n=46), remifentanil was infused at a rate of 0.25mg/kg/min and subsequently increased or decreased by 0.05mg/kg/min per clinical demand. In the low-dose remifentanil (LR) group (n=46), remifentanil was infused at a rate of 0.05mg/kg/min. The incidence of POST was monitored at 0, 2, 4, and 24 hours postoperatively. Complications regarding opioids were compared between groups. Results: The overall incidence of POST was higher in the HR group compared with that in the LR group [33 (72%) vs 18 (39%), P=.022]. The incidence of POST at 0, 2, and 24hours after surgery was higher in the HR group compared with that in the LR group (P<.001, P=.001, and P=.001, respectively). The incidence of postoperative nausea, vomiting, drowsiness, and headache was similar between the groups. The incidence of postoperative shivering was higher in the HR group than in the LR group [10 (22%) vs 2 (4%), difference 17%, 95% CI 2%–33%, P=.027]. Conclusion:A relatively large dose of intraoperative remifentanil increased the incidence of POST in patients for orthopedic surgery under general anesthesia. Trial Registration: Clinicaltrials.gov Identifier: NCT03173339. Abbreviations: ETT = endotracheal tube, HR = high-dose remifentanil, IQR = interquatile rage, LR = low-dose remifentanil, MAC = minimum alveolar concentration, POST = postoperative sore throat.