Comparison of emergence after deep extubation using desflurane or desflurane with remifentanil in patients undergoing general anesthesia: a randomized trial

Abstract Study objective To compare recovery times and respiratory complications during emergence after deep extubation using either desflurane alone or a lower concentration of desflurane with remifentanil. Design Prospective randomized double-blind clinical trial. Setting Intraoperative. Patients A total of 62 patients between the ages of 20 and 60 years with American Society of Anesthesiologists class I or II and who underwent low- to intermediate-risk surgery of 2- to 4-hour duration were enrolled. Interventions Randomly assigned either 1.5 minimum alveolar concentration desflurane (group D; n = 31) or 1.0 minimum alveolar concentration of desflurane and 1.0 ng/mL effect-site concentration of remifentanil (group DR; n = 31). Measurements Recovery times, from the time of extubation to the time when the patients could breathe without assistance, were awake enough to maintain the airway independently, and exited the recovery room, as well as respiratory complications were compared between the groups. Main Results Recovery times were significantly reduced in the group DR ( P < .001). The incidence of respiratory complications was also lower in group DR than in group D (48% vs 3.8%; P < .001). Conclusions The combined use of remifentanil while lowering the concentration of desflurane improves recovery profiles during emergence after deep extubation.