Remifentanil Versus Rocuronium for Optimizing Video Laryngoscopy-assisted Tracheal Intubation in Patients Undergoing General Anaesthesia - a Multicentre Randomised Controlled Trial -The ROCVIDEO Trial

Globally, we are approaching 1 million surgical procedures each day. Tracheal intubation is the mainstay of securing the patient's airway and breathing during general anaesthesia. Approximately 100.000 tracheal intubations are performed annually in Denmark. Airway management remains the primary reason for anaesthesia-related morbidity and mortality. It has been traditionally accepted that best tracheal intubation conditions are obtained by paralysing the patient's muscles, including vocal cords, using a neuromuscular blocking agent (NMBA) such as rocuronium. However, using NBMA may increase the risk of pulmonary complications, intra-operative awareness, in which the patient is paralysed but awake during surgery, anaphylaxis, and re-intubation. In addition, there is a risk of residual neuromuscular blockade postoperatively. In the US, prolonged ventilation and unplanned intubation are the top two most costly perioperative complications. An alternative to NMBA is a large dose of opioids to depress laryngeal reflexes during intubation. The most commonly used non-NMBA modality includes bolus administration of remifentanil. However, remifentanil may cause bradycardia and hypotension. Even short periods of hypotension have been shown to increase the risk of myocardial injury and other serious adverse events such as renal failure, delirium, and even mortality.
Evidence also indicates that intubation conditions using only opioids to facilitate intubation, including remifentanil, are inferior to NMBA. However, these trials are underpowered to assess effects on patient-important outcomes and are mostly at high risk of bias. A recent trial has suggested that remifentanil intubation conditions may not be very different. Almost all existing research comparing NMBA to opioids has focused on intubation conditions for direct laryngoscopy using a conventional Macintosh laryngoscopy blade. In recent years, the implementation and availability of the video laryngoscope have grown exponentially and become universal. The video laryngoscope has vastly improved the ease of tracheal intubation, and the number of failed intubations has decreased by two-thirds in Denmark, where a rapid implementation of the video laryngoscope took place. However, limited evidence exists on whether NMBA improves intubation conditions compared to remifentanil when performing video laryngoscope-assisted tracheal intubation.

Start Date01 Jun 2025

Sponsor / Collaborator-

ChiCTR2400092766 / SuspendedPhase 4IIT

The use of fospropofol disodium injection combined with remifentanil for analgesic and sedative treatment during fiberoptic bronchoscopy in critically ill patients:A single-center, randomized controlled clinical study

Start Date01 Jan 2025

Sponsor / Collaborator-

ChiCTR2400092060 / SuspendedNot ApplicableIIT

Effect of low-dose remifentanil pumped after operation on restlessness and hemodynamics in patients with hypertension during Allen Su during thoracoscopic lobectomy

Start Date01 Dec 2024

Sponsor / Collaborator

Anhui Medical University No. 1 Affiliated Hospital

100 Clinical Results associated with Remifentanil Hydrochloride

100 Translational Medicine associated with Remifentanil Hydrochloride

100 Patents (Medical) associated with Remifentanil Hydrochloride

6,366

Literatures (Medical) associated with Remifentanil Hydrochloride

01 Jan 2025·Brazilian Journal of Anesthesiology

Comparison of the recovery profile of sufentanil and remifentanil in total intravenous anesthesia: a systematic review and meta-analysis of randomized controlled trials

Review

Author: Diehl, Rodrigo Bouchabki de A. ; Cuiabano, Igor Seror ; Diehl, Rodrigo Bouchabki de A ; Naves, Rafael Pagliaro

INTRODUCTION:

Remifentanil is a short-acting opioid and can be administered during surgery without the risk of delayed postoperative recovery but concerns about hyperalgesia and the shortages of remifentanil lead anesthetists to consider long-acting opioids for Total Intravenous Anesthesia (TIVA). Sufentanil is a more potent opioid with a longer context-sensitive half-life but can promote good postoperative analgesia due to its residual effect. This meta-analysis aimed to compare the recovery profile of remifentanil and sufentanil for TIVA.

METHODS:

The search strategy was performed in PubMed, CENTRAL, and Web of Science for RCTs comparing sufentanil and remifentanil as part of TIVA in adults undergoing noncardiac surgery. Risk of bias and the quality of evidence were performed using RoB2 and GRADEpro, respectively. The primary outcome was time to tracheal extubation. Secondary analyses included postoperative analgesia, respiratory depression, and Postoperative Nausea and Vomiting (PONV).

RESULTS:

Sufentanil increases the time to extubate, MD = 4.29 min; 95% CI: 2.33 to 6.26; p = 0.001. It also reduces the need for postoperative rescue analgesia, logOR = -1.07; 95% CI: -1.62 to -0.52; p = 0.005. There were no significant differences between both opioids for PONV, logOR = 0.50; 95% CI: -0.10 to 1.10; p = 0.10 and respiratory depression, logOR = 1.21; 95% CI: -0.42 to 2.84; p = 0.15.

CONCLUSION:

Sufentanil delays the time to tracheal extubation compared with remifentanil but is associated with a reduced need for postoperative rescue analgesia. No significant differences were observed between the two opioids in terms of postoperative respiratory depression or PONV.

01 Jan 2025·BRAIN BEHAVIOR AND IMMUNITY

Remifentanil-induced inflammation in microglial cells: Activation of the PAK4-mediated NF-κB/NLRP3 pathway and onset of hyperalgesia

Article

Author: Cui, Chang ; Zhang, Tianyao ; Dong, Shuhua ; Chen, Benzhen ; Wu, Xiaochu

BACKGROUND:

The perioperative use of remifentanil is associated with postoperative hyperalgesia, which can impair recovery and extend hospitalization. Recent studies have revealed that microglia-mediated activation of the NLRP3 inflammasome plays a critical role in opioid-induced hyperalgesia, with NF-κB acting as a pivotal activation point for NLRP3. Despite these findings, the specific molecular mechanisms underlying remifentanil-induced postoperative hyperalgesia remain unclear. This study aims to develop a model of remifentanil-induced hyperalgesia and investigate the molecular mechanisms, focusing on the NF-κB/NLRP3 pathway, using both in vitro and in vivo approaches.

METHOD:

We established a remifentanil-induced hyperalgesia model and performed proteomic analysis to identify differential protein expression in the spinal cord tissue of rats. NLRP3 or PAK4 antagonists were administered intrathecally in vivo, and mechanical pain thresholds in the hind paws were measured using Von Frey testing. In vitro, we applied NLRP3 or PAK4 inhibitors or used lentivirus infection to silence PAK4, NF-κB, and NLRP3 genes. Protein expression was assessed through immunohistochemistry, immunofluorescence, and Western blotting. Additionally, ELISA was performed to measure IL-1β and IL-18 levels, and RT-qPCR was conducted to evaluate the transcription of target genes.

RESULTS:

Proteomic analysis revealed that remifentanil upregulates PAK4 protein in spinal cord tissue two hours after the surgery. In addition, remifentanil induces morphological changes in the spinal cord dorsal horn, characterized by increased expression of PAK4, p-p65, NLRP3 and Iba-1 proteins, which in turn leads to elevated IL-1β and IL-18 levels and an inflammatory response. Intrathecal injection of NLRP3 or PAK4 inhibitors mitigates remifentanil-induced hyperalgesia and associated changes. In vitro, downregulation of PAK4 inhibits the increase in PAK4, p-p65, NLRP3 and Caspase-1 induced by LPS. Conversely, the downregulation of NLRP3 does not impact the levels of PAK4 and p-p65 proteins, aligning with the in vivo results and suggesting that PAK4 acts as an upstream signaling molecule of NLRP3.

CONCLUSION:

Remifentanil can increase PAK4 expression in spinal cord dorsal horn cells by activating the NF-κB/NLRP3 pathway and mediating microglial activation, thereby contributing to postoperative hyperalgesia.

31 Dec 2024·Annals of medicine

Efficacy of intraoperative systemic lidocaine on quality of recovery after laparoscopic colorectal surgery: a randomized controlled trial

Article

Author: Lin, Wenjun ; Qiu, Chunlin ; Guo, Yanhua ; Zhuo, Yifen ; Yang, Ying ; Yao, Yusheng

INTRODUCTION:

Many clinical trials have demonstrated the benefits of intraoperative systemic lidocaine administration in major abdominal surgeries. We tested the hypothesis that systemic lidocaine is associated with an enhanced early quality of recovery in patients following laparoscopic colorectal resection.

PATIENTS AND METHODS:

We randomly allocated 126 patients scheduled for laparoscopic colorectal surgery in a 1:1 ratio to receive either lidocaine (1.5 mg kg^-1 bolus over 10 min, followed by continuous infusion at 2 mg kg^-1 h^-1 until the end of surgery) or identical volumes and rates of saline. The primary outcome was the Quality of Recovery-15 score assessed 24 h after surgery. Secondary outcomes were areas under the pain numeric rating scale curve over time, 48-h morphine consumption, and adverse events.

RESULTS:

Compared with saline, systemic lidocaine improved the Quality of Recovery-15 score 24 h postoperatively, with a median difference of 4 (95% confidence interval: 1-6; p = 0.015). Similarly, the area under the pain numeric rating scale curve over 48 h at rest and on movement was reduced in the lidocaine group (p = 0.004 and p < 0.001, respectively). However, these differences were not clinically meaningful. Lidocaine infusion reduced the intraoperative remifentanil requirements but not postoperative 48-h morphine consumption (p < 0.001 and p = 0.34, respectively). Additionally, patients receiving lidocaine had a quicker and earlier return of bowel function, as indicated by a shorter time to first flatus (log-rank p < 0.001), yet ambulation time was similar between groups (log-rank test, p = 0.11).

CONCLUSIONS:

In patients undergoing laparoscopic colorectal surgery, intraoperative systemic lidocaine resulted in statistically but not clinically significant improvements in quality of recovery (see Graphical Abstract).Trial registration: Chinese Clinical Trial Registry; ChiCTR1900027635.

News (Medical) associated with Remifentanil Hydrochloride

10 Dec 2024

·www.echemi.com

Remarkable Sales Discrepancy of Remimazolam: $40 Million in China, Only $800,000 in the U.S.

In recent years, among the new anesthetic sedation drugs launched on the market, Remazolam has undoubtedly aroused widespread concern in the industry. The drug was designed and synthesized by GlaxoSmithKline (GSK) in 1999, and after several corporate transfers, it was approved for market in China, the United States, Europe and other countries and regions around 2020. However, there are significant differences in the market performance of remazolam across countries. According to 2023 data, the drug's sales in China are about $40 million, while in the United States it is only $800,000, accounting for only 2% of the Chinese market. The reasons for this difference are worth exploring in depth. Remazolam is an ultra-short-acting GABAA receptor agonist whose design is inspired by midazolam and remifentanil, combining the properties of both. It is rapidly metabolized by carboxylesterases in the liver to produce inactive metabolites, resulting in rapid sedation resolution and short sedation recovery time. Remazolam's development history dates back to 1999, when GSK designed and synthesized the drug based on remifentanil's properties and filed a patent application. The patent was then transferred to TheraSci in the United Kingdom. Paion began developing the drug in 2008. Due to the instability of remazolam's free base, Paion developed remazolam benzenesulfonate, while Hengrui Pharmaceuticals adopted remazolam in the form of (toluene sulfonate) salt. At present, these two salt types of remazolam have been listed, of which Remazolam toluene sulfonate is only listed in China, while Remazolam benzenesulfonate is listed in China, Japan, the United States, Europe and other countries, but there are differences in indications. In the Chinese market, RenFCM obtained the Chinese market rights of Remazolam besylate in 2012, and was approved by the State Food and Drug Administration for sedation in colonoscopy in 2020, followed by the induction and maintenance of general anesthesia and the indication of bronchoscopic sedation. In the United States, Remazolam besylate was approved in July 2020 under the trade name Byfavo for a 30-minute sedation procedure marketed by Eagle. Remazolam besylate is approved for induction and maintenance of general anesthesia in Japan and South Korea. It is worth noting that in the first quarter of 2024, Paion was acquired by China's Renfu Pharmaceutical, which means that the global interests of Remazolam besylate have been vested in Renfu Pharmaceutical. Remazolam toluene sulfonate was first approved for sale in China in 2019 for indications including induction and maintenance of general anesthesia and sedation during colonoscopy. The difference in sales in the U.S. and China markets may be related to the different range of indications approved for remazolam in different countries. In the United States, Remazolam is only approved for procedural sedation, while in China, its approved indications include general anesthesia and sedation, and sales are significantly higher than in the United States. In addition, the difference in sales performance between China and the United States may also be related to concerns about remazolam metabolites. Remazolam is metabolized in the body to produce methanol, which may be further oxidized to formaldehyde and formic acid, and formaldehyde is potentially cytotoxic. As a result, the FDA requires remazolam to be administered only within 0.5 hours to avoid the buildup of methanol and its metabolites to dangerous levels. At present, other anesthetic sedatives commonly used in clinical practice, such as propofol, benzodiazepines (represented by midazolam), and α-receptor agonists (represented by dexmetropil), all have their own shortcomings. Although Remazolam still has room for improvement in some aspects, its unique advantages, such as rapid onset, rapid metabolism, rapid sedation recovery, etc., make it a potential application value in the field of anesthesia sedation. With the advancement of medical technology and the in-depth exploration of clinical applications, there may be an improved version of remazolam in the future, bringing new options to the field of anesthesia sedation.

Drug ApprovalAcquisitionPatent ExpirationBiosimilar

08 Aug 2024

·www.echemi.com

Humanwell Healthcare Reports 3.86% Revenue Growth in H1 2024

The latest release shows that Humanwell Healthcare has delivered remarkable results in the first half of 2024, demonstrating excellent market performance. Specifically, the company managed to achieve solid growth in total operating revenue, totaling RMB12.861 billion, an increase of 3.86% over the same period last year, marking the fourth consecutive year of good growth for Humanwell Healthcare. Despite some fluctuations in net profit, Humanwell Healthcare's core subsidiary, Yichang Humanwell, maintained strong growth momentum and achieved double-digit growth rates, providing strong support for the company's overall performance. As a leading pharmaceutical company in China, Humanwell Healthcare has been committed to the research and development, production and sales of pharmaceutical products since its establishment in 1993. Headquartered in Wuhan, Hubei Province, Humanwell Healthcare is a key player in China's pharmaceutical industry. Humanwell Healthcare's product line is rich and diverse, including many star products. Compound Cloloterol propionate tablet, as one of the company's core products, is an oral drug for type 2 diabetes, which has the effect of significantly reducing blood sugar and protecting islet function, and enjoys a high reputation in the field of diabetes treatment in China. Gastrodine capsule is a Chinese medicine preparation for the treatment of ischemic stroke sequelae, which can significantly improve the blood supply to the brain and promote the repair of nerve function, and is an important representative of the company in the field of Chinese medicine. In addition, as the company's main product in the field of respiratory treatment, trimebutin tablets can effectively improve the respiratory function of patients with chronic obstructive pulmonary disease (COPD), and occupy an important position in the domestic COPD treatment market. Humanwell Healthcare continues to consolidate and expand its market leadership in the key area of neurological medicine. The company's two star narcotic products - remifentanil hydrochloride for injection and sufentanil citrate injection, the performance of the national hospital market in 2023 is particularly eye-catching. The combined sales of these two products reached 6.778 billion yuan, accounting for more than 40% of the market share. Among them, remifentanil hydrochloride for injection is as high as 90.28% of the market share, sitting firmly on the throne of "anesthesia first", its market position is rock-solid. Humanwell Healthcare will continue to uphold the philosophy of continuous innovation and excellence to further consolidate its leading position in the field of anesthetics. At the same time, the company will also accelerate the research and development process of new product pipelines, actively expand other therapeutic areas, and continuously improve its overall competitive strength with a diversified product portfolio and strong research and development strength. We firmly believe that with the joint efforts of all employees, Humanwell Healthcare will be able to create even more brilliant results and bring even greater returns to shareholders.

Drug Approval

26 Jun 2024

·www.prnewswire.com

Medasense Announces a Strategic Agreement With Global Medical Company, Nihon Kohden Corporation

RAMAT GAN, Israel, June 26, 2024 /PRNewswire/ -- Medasense, a global leader in pain monitoring solutions, is proud to announce a strategic partnership with Nihon Kohden for the exclusive distribution of its revolutionary pain monitoring device in Japan. This partnership is intended to transform pain management practices across Japanese healthcare facilities, offering a significant advancement in patient care. Nihon Kohden, renowned for its history of excellence in providing innovative high quality, reliable medical technology that improves the way healthcare is practiced, is partnering with Medasense to introduce its nociception monitor to the Japanese market. This cutting-edge device, with its state-of-the-art AI powered NOL - Nociception Level Index®, provides real-time, objective pain monitoring, enabling the personalization and optimization of pain treatment. It will be accessible to hospitals and clinics throughout Japan through Nihon Kohden's extensive distribution channels pending regulatory approval. Medasense's CEO & Founder, Galit Zuckerman, expressed enthusiasm about the collaboration: "We are honored to partner with Nihon Kohden, a company with a long history of excellence, that shares our vision of improving patient care through innovative solutions. Our mission is to help all patients suffer less from pain and the adverse effects of pain medication. Nihon Kohden's established clinical, technological leadership and expertise in the Japanese market make them the perfect partner to distribute our nociception monitor." NOL monitoring provides an AI powered, clinically validated index to objectively quantify the physiological response to pain (nociception) supporting clinicians in delivering personalized anesthesia tailored to patient requirements. With over 40 peer reviewed publications, clinical studies have demonstrated that NOL-guided analgesia resulted in intraoperative opioid sparing, and improved post operative pain scores and patient recovery.1,2 For more information about Medasense and Nihon Kohden, please visit and . About Medasense and NOL – Nociception Level Index® Technology Medasense is transforming pain management with its breakthrough technology that empowers clinicians to optimize and personalize pain control, significantly reducing the risk of pain or of overmedication. The company's flagship product, the PMD-200™, equipped with the NOL-Nociception Level Index®, leverages advanced artificial intelligence and a proprietary non-invasive sensor system. This unique platform provides objective monitoring and quantification of a patient's pain response, making it an essential tool in an operating room and critical care unit settings where patients cannot communicate their pain levels. The PMD-200 is the first and only monitor to be authorized by the FDA for pain measurement for anaesthesiology. It has been used in over 100,000 surgeries worldwide, and is commercially available in the US, Europe, Canada, Latin America and Israel. Watch Medasense's 1-minute video About Nihon Ko hden Founded in 1951, Nihon Kohden is a global leader of medical solutions with the goal to improve healthcare with advanced technology. For more than 70 years, Nihon Kohden has continued to provide a wide range of medical electronic equipment including EEG, EMG/EP measuring systems, electrocardiographs, bedside monitors, defibrillators, AEDs, ventilators, and hematology instruments. Nihon Kohden utilizes cutting-edge technology to support medical treatment in all clinical areas, integrating medical devices into the IT network to meet customers' requirements and offers a wide, comprehensive solution. For further information please contact: Rachel Weissbrod, VP Clinical & Market Development, Medasense +972-54-544-9115 [email protected] 1. Meijer, F., Honing, M., Roor, T., Toet, S., Calis, P., Olofsen, E., Martini, C., van Velzen, M., Aarts, L., Niesters, M., Boon, M., Dahan, A. (2020). Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial. British Journal of Anaesthesia, In Press. DOI: 2. Fleur S. Meijer, Chris H. Martini, Suzanne Broens, Martijn Boon, Marieke Niesters, Leon Aarts, Erik Olofsen, Monique van Velzen, Albert Dahan. Nociception-guided versus Standard Care during Remifentanil–Propofol Anesthesia: A Randomized Controlled Trial. Anesthesiology (2019); 130:745–755 Logo:

100 Deals associated with Remifentanil Hydrochloride

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KEGG	Wiki	ATC	Drug Bank
D01177	Remifentanil Hydrochloride	N01AH06	DB00899

R&D Status

Approved

10 top approved records.

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Indication	Country/Location	Organization	Date
Pain	CH	GSK Plc	28 Jan 1997
Anesthesia	US	Mylan Institutional LLC	12 Jul 1996

Developing

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Analgesia	Phase 3	DE	GSK Plc	01 Nov 2006
Sedation	Phase 3	DE	GSK Plc	01 Nov 2006
Hyperalgesia	Phase 1	DE	Air Liquide Santé (International) SA	01 Jan 2012

Clinical Result

Indication

Phase

Evaluation

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT04734418 (Pubmed \| J Intensive Care) Manual	Not Applicable	-	179	Remifentanil	isgloxmcnn(dwwdjjmhjz) = pgagiifaio roexkimxwe (fqhktmaerl ) View more	Negative	18 Sep 2024
				Dexmedetomidine	isgloxmcnn(dwwdjjmhjz) = gpxngtyedn roexkimxwe (fqhktmaerl ) View more
NCT02631135 (CTgov)	Phase 4	-	40	Propofol+Rocuronium+Remifentanil (Group 1 (TIVA))	qiprxlmuee(cqplcnydzx) = devfietvjx krrfsfbbjz (blyzolggij, zabkyhymfa - nhakdujtad) View more	-	17 May 2024
				Dexmedetomidine+Propofol+Rocuronium+Remifentanil (Group 2 (TIVA+D))	qiprxlmuee(cqplcnydzx) = qqmridhjql krrfsfbbjz (blyzolggij, bjmckuixdn - qvisyxastw) View more
NCT03207100 (Pubmed) Manual	Not Applicable	Cerebral Hemorrhage	338	remifentanil grdexmedetomidineil and dexmedetomidine)	rkgyllsxqu(pazfnltcme) = gxzomtwxrq qzcukdcmuq (moegoscmwl )	Positive	27 Mar 2024
				remifentanil (Control group (standard guideline-based management))	rkgyllsxqu(pazfnltcme) = afihupwyfh qzcukdcmuq (moegoscmwl )
NCT03643796 (CTgov)	Phase 4	Intervertebral Disc Disease	32	Remifentanil (Remifentanil Group)	bstpbapedj(bcaalzanwf) = ygpwrhdtvg mxrxuupxzj (dvrxvfojnc, qdssleyupw - pdeqftfzaj) View more	-	18 Sep 2023
				Dexmedetomidine+Ketamine (Ketamine and Dexmedetomidine Group)	bstpbapedj(bcaalzanwf) = wjrevgbmmg mxrxuupxzj (dvrxvfojnc, ndcrddpqwd - ppqotoxxsk) View more
ChiCTR2100054565 (Pubmed \| BMC Anesthesiol)	Phase 4	-	-	Remifentanil	uowoohfcar(yjhdrwgjfd) = which occurred in 3 patients xjkiimanlt (jmxjdaokpe )	-	28 Jun 2023
NCT02989597 (MAPS, CTgov)	Phase 4	Pain, Postoperative	10	Spinal Fusion Surgery+Sufentanil+Methadone Hydrochloride+Dexamethasone+ketamine+Remifentanil (Intra-operative Methadone Hydrochloride)	vjiafxroem(dldunxufue) = towdmtbvbp uzqpdolobv (orkgwcshbv, nxghqdpcdk - llhvylowcl) View more	-	25 Apr 2023
				Spinal Fusion Surgery+Sufentanil+Dexamethasone+ketamine+Remifentanil (Control)	vjiafxroem(dldunxufue) = vreyrhkiiw uzqpdolobv (orkgwcshbv, oxoqcajwdy - uyklcbrkzq) View more
NCT03283150 (CTgov)	Phase 4	Brain Diseases \| Sedation	20	Remifentanil (Remifentanil)	ybthuxflid(jagryfleuy) = fntbyjcyzn bvqoqjwxyc (ezzgxrtwje, vvffwzdvbs - mwoefmfjzy) View more	-	27 Mar 2023
				Propofol (Propofol)	slsrcrzzpa(lfdnxuenqs) = stqwbmrbqd ntpvwdxoty (gbkmuthnwh, kmobxpeqfa - noenvycauw) View more
NCT05217238 (Pubmed \| Pain Ther)	Not Applicable	Pain	-	Remifentanil (Group R1)	cmatggazfa(cjpmxikobz) = avlkjlvvjp tzydzxajyo (gpkychvgjv, 1.186 - 1.351)	-	08 Mar 2023
				Remifentanil (Group R2)	cmatggazfa(cjpmxikobz) = vdwwemgigc tzydzxajyo (gpkychvgjv, 1.065 - 1.324)
NCT03960801 (Pubmed \| JAMA)	Phase 3	-	1,150	Neuromuscular blockers	rcjepoeygw(gskwebcxnq) = lwewjbsawv vmksssuiee (twdaurqrag )	-	03 Jan 2023
				Remifentanil	rcjepoeygw(gskwebcxnq) = ewjeqaiata vmksssuiee (twdaurqrag )
Pubmed \| Curr Pharm Des	Not Applicable	Cough \| Anesthesia	-	Ramosetron 0.3 mg	hwwzdlhcmg(aersutafhn) = bxvmamcwfd ffzvrynxlo (akhozkcmic ) View more	-	12 Apr 2022
				Normal saline	hwwzdlhcmg(aersutafhn) = ehmkmpmcfb ffzvrynxlo (akhozkcmic ) View more

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