Effects of different doses of sufentanil and remifentanil combined with propofol in target-controlled infusion on stress reaction in elderly patients

Hu,Li-Guo; Pan,Jian-Hui; Li,Juan; Kang,Fang; Jiang,Ling

doi:10.3892/etm.2013.900

Effects of different doses of sufentanil and remifentanil combined with propofol in target-controlled infusion on stress reaction in elderly patients

Authors:
- Li-Guo Hu
- Jian-Hui Pan
- Juan Li
- Fang Kang
- Ling Jiang
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Affiliations: Department of Anesthesiology, The Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China, Department of Pharmacy, The Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, P.R. China
Published online on: January 17, 2013 https://doi.org/10.3892/etm.2013.900
Pages: 807-812

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Abstract

The current study aimed to observe the effects of sufentanil and remifentanil combined with propofol in target‑controlled infusion (TCI) on perioperative stress reaction in elderly patients. A total of 80 elderly patients requiring general anesthesia were recruited. They were divided into four groups (each n=20) according to different target concentrations of remifentanil and sufentanil. These target concentrations were: 4 ng/ml remifentanil + 0.2 ng/ml sufentanil for group I; 3 ng/ml remifentanil + 0.3 ng/ml sufentanil for group II; 2 ng/ml remifentanil + 0.5 ng/ml sufentanil for anesthesia induction and post-intubation 3 ng/ml remifentanil + 0.2 ng/ml sufentanil for anesthesia maintenance for group III; and 5 ng/ml remifentanil for anesthesia induction and post-intubation 4 ng/ml remifentanil for anesthesia maintenance for group IV. Norepinephrine (NE), epinephrine (E) and angiotensin II (Ang II) levels in plasma were measured prior to the induction of anesthesia, as well as at several different time-points following surgery. The numbers of intraoperative severe hemodynamic fluctuation, postoperative eye-opening and extubation time, and post-extubation restlessness and pain scores were recorded. Group IV had a larger circulation fluctuation control number and higher levels of NE, E and Ang II at 3 h after surgery than any other group (P<0.01). Although group IV had shorter postoperative eye-opening and extubation times compared with the other groups (P<0.05), it also had higher restlessness and pain scores (P<0.01). The combined use of sufentanil and remifentanil stabilizes perioperative hemodynamics and reduces stress hormone levels.

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1.	Sieber FE and Pauldine R: Geriatric anesthesia. Miller’s anesthesia. Miller RD: 7th edition. Philadelphia: Churchill Livingstone; pp. 2261–2276. 2010
2.	Park SH, Jeong ST, Tak YJ, Kim CS and Kim ST: A comparison of the hemodynamic changes and propofolinduced pain at two different doses of remifentanil in elderly patients. Korean J Anesthesiol. 58:532–536. 2010. View Article : Google Scholar : PubMed/NCBI
3.	Ouattara A, Boccara G, Lemaire S, et al: Target-controlled infusion of propofol and remifentanil in cardiac anaesthesia: influence of age on predicted effect-site concentrations. Br J Anaesth. 90:617–622. 2003. View Article : Google Scholar
4.	Derrode N, Lebrun F, Levron JC, Chauvin M and Debaene B: Influence of peroperative opioid on postoperative pain after major abdominal surgery: sufentanil TCI versus remifentanil TCI. A randomized, controlled study. Br J Anaesth. 91:842–849. 2003. View Article : Google Scholar
5.	Motamed C, Merle JC, Yakhou L, et al: Postoperative pain scores and analgesic requirements after thyroid surgery: comparison of three intraoperative opioid regimens. Int J Med Sci. 3:11–13. 2006. View Article : Google Scholar
6.	Michelsen LG and Hug CC Jr: The pharmacokinetics of remifentanil. J Clin Anesth. 8:679–682. 1996. View Article : Google Scholar : PubMed/NCBI
7.	Lee C, Song YK, Lee JH and Ha SM: The effects of intraoperative adenosine infusion on acute opioid tolerance and opioid induced hyperalgesia induced by remifentanil in adult patients undergoing tonsillectomy. Korean J Pain. 24:7–12. 2011. View Article : Google Scholar
8.	Guignard B, Bossard AE, Coste C, et al: Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology. 93:409–417. 2000. View Article : Google Scholar
9.	Gu X, Wu X, Liu Y, Cui S and Ma Z: Tyrosine phosphorylation of the N-Methyl-D-Aspartate receptor 2B subunit in spinal cord contributes to remifentanil-induced postoperative hyperalgesia: the preventive effect of ketamine. Mol Pain. 30:76–85. 2009. View Article : Google Scholar
10.	Leysen JE, Gommeren W and Niemegeers CJ: [³H] Sufentanil, a superior ligand for mu-opiate receptors: binding properties and regional distribution in rat brain and spinal cord. Eur J Pharmacol. 87:209–225. 1983.
11.	Niemegeers CJ, Schellekens KH, Van Bever WF and Janssen PA: Sufentanil, a very potent and extremely safe intravenous morphine-like compound in mice, rats and dogs. Arzneimittelforschung. 26:1551–1556. 1976.PubMed/NCBI
12.	Cafiero T, Di Minno RM, Sivolella G and Di Iorio C: Immediate postoperative pain management in patients undergoing major abdominal surgery after remifentanil-based anesthesia: sufentanil vs tramadol. Minerva Anestesiol. 70:661–669. 2004.
13.	Akural EI, Salomäki TE, Tekay AH, Bloigu AH and Alahuhta SM: Pre-emptive effect of epidural sufentanil in abdominal hysterectomy. Br J Anaesth. 88:803–808. 2002. View Article : Google Scholar : PubMed/NCBI
14.	Carrer S, Bocchi A, Candini M, Donegà L and Tartari S: Short term analgesia based sedation in the Intensive Care Unit: morphine vs remifentanil + morphine. Minerva Anestesiol. 73:327–332. 2007.PubMed/NCBI
15.	Nora FS: Total intravenous anesthesia as a target-controlled infusion. An evolutive analysis. Rev Bras Anestesiol. 58:179–192. 2008.PubMed/NCBI
16.	Zhao Y, Zhang LP, Wu XM, et al: Clinical evaluation of target controlled infusion system for sufentanil administration. Chin Med J (Engl). 122:2503–2508. 2009.PubMed/NCBI
17.	Yang XY, Xu X and Wu XM: A comparison of remifentanil versus sufentanil with target-controlled infusion in combined inhalation anesthesia for surgical patients: effects on hemodynamics and postoperative recovery. Zhonghua Yi Xue Za Zhi. 29:828–831. 2011.(In Chinese).
18.	Albertin A, Casati A, Federica L, et al: The effect-site concentration of remifontanil blunting cardiovascular responses to tracheal intubation and skin incision during bispectral index-guided prpofol anesthesia. Anesth Analg. 101:125–130. 2005. View Article : Google Scholar
19.	Bourgoin A, Albanèse J, Léone M, Sampol-Manos E, Viviand X and Martin C: Effects of sufentanil or ketamine administered in target-controlled infusion on the cerebral hemodynamics of severely brain-injured patients. Crit Care Med. 33:1109–1113. 2005. View Article : Google Scholar
20.	Hentgen E, Houfani M, Billard V, Capron F, Ropars JM and Travagli JP: Propofol-sufentanil anesthesia for thyroid surgery: optimal concentrations for hemodynamic and electroencephalogram stability, and recovery features. Anesth Analg. 95:597–605. 2002.
21.	Habib AS, Parker JL, Maguire AM, Rowbotham DJ and Thompson JP: Effects of remifentanil and alfentanil on the cardiovascular responses to induction of anaesthesia and tracheal intubation in the elderly. Br J Anaesth. 88:430–433. 2002. View Article : Google Scholar : PubMed/NCBI
22.	Célèrier E, Laulin JP, Corcuff JB, Le Moal M and Simonnet G: Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: a sensitization process. J Neurosci. 21:4074–4080. 2001.PubMed/NCBI
23.	Colvin LA and Fallon MT: Opioid induced hyperalgesia: a clinical challenge. Br J Anaesth. 104:125–127. 2010. View Article : Google Scholar : PubMed/NCBI
24.	Tsai RY, Tai YH, Tzeng JI, Cherng CH, Yeh CC and Wong CS: Ultra-low dose naloxone restores the antinociceptive effect of morphine in pertussis toxin-treated rats by reversing the coupling of mu-opioid receptors from Gs-protein to coupling to Gi-protein. Neuroscience. 164:435–443. 2009. View Article : Google Scholar : PubMed/NCBI
25.	Zhao M and Joo DT: Enhancement of spinal N-methyl-D-aspartate receptor function by remifentanil action at delta-opioid receptors as a mechanism for acute opioid-induced hyperalgesia or tolerance. Anesthesiology. 109:308–317. 2008. View Article : Google Scholar : PubMed/NCBI
26.	He SQ, Zhang ZN, Guan JS, et al: Facilitation of µ-opioid receptor activity by preventing δ-opioid receptor-mediated codegradation. Neuron. 69:120–131. 2011.
27.	Breslow MJ: The role of stress hormones in perioperative myocardial ischemia. Int Anesthesiol Clin. 30:81–100. 1992. View Article : Google Scholar : PubMed/NCBI
28.	Hitomi H, Kiyomoto H and Nishiyama A: Angiotensin II and oxidative stress. Curr Opin Cardiol. 22:311–315. 2007. View Article : Google Scholar