Effect-site concentrations of remifentanil for smooth emergence from combined epidural–general anesthesia or general anesthesia in patients using video double-lumen tube: A randomized trial

OBJECTIVE: The present study aimed to determine the effect-site concentration of remifentanil of 90% (EC(90)) for smooth emergence in patients with a video DLT (VDLT) under sevoflurane-maintained general anesthesia and to investigate whether the EC(90) was affected by epidural anesthesia. METHODS: One hundred and twenty patients who underwent video-assisted thoracic surgery (VATS) were enrolled. Patients received either general anesthesia combined with epidural anesthesia (PEA group, n = 60) or general anesthesia (GA group, n = 60). The primary outcome was the EC(90) for smooth emergence in both groups. The secondary outcomes were intraoperative emergence, smooth emergence, recovery, and hemodynamic profiles in both groups. RESULT: The EC(90) values for smooth emergence in patients using VDLT were 3.5 ng/ml (95% confidence interval [CI], 3.3–4.4 ng/ml) in the PEA group and 2.7 ng/ml (95% CI, 2.5–3.2 ng/ml) in the GA group. The total amount of remifentanil infusion during emergency was significantly higher in the PEA group (164.6 ± 47.9 μg) than in the GA group (127.1 ± 30.4 μg) (P < 0.001). The number of patients who experienced hypotension during emergency in the PEA group was higher than that in the GA group (46.7% versus 13.3%, P < 0.001). CONCLUSION: The EC(90) of remifentanil for smooth emergence in patients with VDLT under general anesthesia combined with epidural anesthesia (3.5 ng/ml) was higher than that under general anesthesia (2.7 ng/ml). TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR2100054230.