Effect of esketamine on the EC50 of remifentanil for suppression of choking cough during extubation.

Choking cough during awakening from anesthesia is common (15%-94%) and can cause severe discomfort and complications, especially in neck surgery. This study compared the median effective concentration (EC50) of remifentanil combined with esketamine versus remifentanil alone for suppressing cough during extubation in male patients undergoing anterior cervical spine surgery. Group E received 0.25 mg/kg esketamine intravenously 30 min before surgery ended, while group D received a placebo. We observed that the EC50 values were 1.88 ng/mL for group E and 2.55 ng/mL for group D. No significant differences were observed in intraoperative hemodynamics or extubation time. Additionally, group E had lower postoperative pain scores at 2 and 24 h. Findings suggest that combining esketamine with remifentanil reduces the EC50 for cough suppression and effectively lowers early postoperative pain, providing reference for perioperative safety and improvement of prognosis in patients undergoing anterior cervical surgery.