Original contributionThe effects of remifentanil and alfentanil-based total intravenous anesthesia (TIVA) on the endocrine response to abdominal hysterectomy
Introduction
Remifentanil is a highly potent μ-opioid receptor agonist, belonging to the class of 4-anilopiperidine derivates. The onset of action of remifentanil is similar to that of alfentanil. However, unlike other opioids, it has a rapid offset of action due to its metabolism by nonspecific blood and tissue esterases.1, 2, 3
Total intravenous anesthesia (TIVA) regimen with remifentanil and propofol is a useful anesthetic technique, effectively controlling responses to tracheal intubation and intense surgical stimulation while allowing for rapid emergence from anesthesia.4 In addition, clinical studies have shown that remifentanil provides better intraoperative hemodynamic stability than does alfentanil.1, 5, 6
Surgery evokes an endocrine response that is characterized by the enhanced secretion of catabolic hormones, such as cortisol and catecholamines, and a decrease in anabolic hormones, such as insulin and testosterone.7, 8 To date, there have been no studies in the literature that have compared the effects of remifentanil and alfentanil anesthesia on the endocrine response to surgery.
The aims of this study were to compare the effects of propofol-remifentanil and propofol-alfentanil anesthesia on plasma concentrations of cortisol, insulin, and glucose, and hemodynamic changes.
Section snippets
Materials and methods
After Ethics Committee Approval by the Medical Faculty of Harran University, and patients' written, informed consent, 24 female, ASA physical status I patients, scheduled to undergo elective abdominal hysterectomy, were studied. None of the patients had cardiovascular, renal, hepatic, or hormonal disorders, or was receiving any medication. On the day of surgery, patients were allocated, via a table of random numbers, to receive either remifentanil-propofol anesthesia (Group R, n = 12) or
Results
Demographic characteristics, as well as the duration of anesthesia and surgery, were similar between groups (Table 1 ).
An increase in MAP was primarily a hemodynamic response to stimuli. The number of patients with response to intubation, skin incision, and surgical stimuli were higher in Group A than Group R, although these differences did not reach statistical significance (Table 2). Hypotension (requiring decreases in opioid infusion rates) occurred in three patients in Group R and one
Discussion
In our study, the occurrence of hypertension and tachycardia in response to intubation, skin incision, and surgical stimuli was controlled effectively by both anesthetic regimens. Because of the pharmacokinetic differences between the two opioids, it was not possible to administer alfentanil infusions at an equipotent dose to remifentanil because of the risk of delayed recovery and prolonged respiratory depression at higher infusion doses of alfentanil.1 Therefore, the infusion rate of study
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Remifentanil and perioperative glycaemic response in cardiac surgery: an open-label randomised trial
2020, British Journal of AnaesthesiaCitation Excerpt :This study tested the hypothesis that remifentanil infusion decreases both hyperglycaemia and insulin requirement during cardiac surgery, based on the assumption that the hormonal stress response, as opposed to decreased insulin secretion, is the major driver of hyperglycaemia during cardiac surgery.2,7 Remifentanil was chosen as it has been shown to suppress the stress response during various surgical procedures.8–13 Fewer patients in the remifentanil group had hyperglycaemic episodes during surgery, despite receiving less insulin.
Neurosurgical Anesthesia: Optimizing Outcomes with Agent Selection
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Assistant Professor of Anesthesiology
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Assistant Professor of Biochemistry
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Research Anesthesiologist