Ramírez-Guerrero JA, Bueno-Albores S, Dávila-Quesada A

Language: Spanish
References: 27
Page: 9-14
PDF size: 389.92 Kb.

ABSTRACT

Objective: To describe the intraoperative behavior and characteristics of recovery of patients undergoing video laparoscopic surgeries with remifentanyl. Methods: Forty patients, ASA I and II were included in this prospective, descriptive study. The induction was with remifentanyl 1 µg/kg in two minutes, propofol 1-1.5 mg/kg and rocuronio 0.6 mg/kg. Sevoflurane was kept constant at 0.7 MAC and a remifentanyl infusion (no more that 0.25 µg/kg/min) was titrated to autonomic responses. Before starting the surgery the skin was infiltrated with lidocaine and before the end of the surgery 30 mg of ketorolac was applied. The infusion was suspended at the start of skin suture, and sevoflurane was suspended with the last suture. Results: Variations in mean arterial pressure and hearth rate post intubation were minimal. Spontaneous breathing appeared 362 ± 163 seconds after closing the infusion of remifentanyl, and extubation was achieved at 545 ± 162 seconds. The mean dose of remifentanyl was 0.165 µg/kg/min. 72% of patients achieved pass on their own to transfer stretcher and in the post anesthetic unit 67.5% of the patients had a value of 5 in the OAAS scale. Twenty three patients required tramadol and 27.5% had nausea. Conclusion: Remifentanyl in the doses used blocked the response to intubation, provide adequate intraoperative cardiovascular stability, with very fast emergence after discontinuation of the inhalational agents in patients undergoing laparoscopic surgery.

REFERENCES

1. Lesley J, Scott and Caroline M. Perry. Remifentanyl. A review of its use during the induction and maintenance of general anaesthesia. Drugs 2005;65:1793-1823.

2. Glass PS, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanyl (GI87084B). Anesth Analg 1993;77:1031-40.

3. Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics and rational opioid selection. Anesthesiology 1991;74:53-63.

4. Olmos M, Ballester JA, Vidarte MA, Elizalde JE, Escobar A. The combined effect of age and premedication on the propofol requirements for induction by target- controlled infusion. Anesth Analg 2000;90:1157–61.

5. Conway DH, Hasan SK, Simpson ME. Target-controlled propofol requirements at induction of anaesthesia: effect of remifentanyl and midazolam. Eur J Anaesthesiol 2002;19:580-584.

6. Rivera R, Antognini JF. Perioperative drug therapy in elderly patients. Anesthesiology 2009;110:1176–81.

7. Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the observer’s assessment of alertness/sedation scale: study with intravenous midazolam. J Clin Psychopharmacol 1994;10:244–51.

8. Damen SL, Nieuwenhuijs VB, Josten W, Houwwling PL, Clevers GJ. The effects of remifentanyl and sufentanyl on the quality of recovery after day case laparoscopic cholecystectomy: A randomized blinded trial. Journal of Laparoendoscopic & Advanced Surgical Techniques 2004;14:87-92.

9. Casati A, Fanelli G, Albertin A, Danelli G, Grifoni F, Torri G. Small doses of remifentanyl or sufentanyl for blunting cardiovascular changes induced by tracheal intubation: a double-blind comparison. Eur J Anaesth 2001;18:108-112.

10. Manyam C, Gupta DK, Johnson K B, White JL, Pace NL, Westenskow DR, Egan TD. Opioid–volatile anesthetic synergy. A response surface model with remifentanyl and sevoflurane as prototypes. Anesthesiology 2006;105:267–78.

11. Katoh T, Kobayashi S, Suzuki A, Iwamoto T, Bito H, Ikeda K. The effect of fentanyl on sevoflurane requirements for somatic and sympathetic responses to surgical incision. Anesthesiology 1999;90:398-405.

12. Albertin A, Casati A, Bergonzi P, Fano G, Torri G. Effects of two target-controlled concentrations (1 and 3 ng/mL) of remifentanyl on MACBAR of sevoflurane. Anesthesiology 2004;100:255–9.

13. Feria-Segura D, Olvera-Morales G, Escobar-Escobar N, Silva-Jiménez A. Respuesta hemodinámica comparando el uso de fentanyl-sevofluorano vs remifentanyl-sevofluorano en colecistectomía laparoscópica. Rev Mex Anest 2009;32:171-176.

14. Muñoz HR, Cortínez LI, Altermatt FR, Dagnino JA. Remifentanyl requirements during sevoflurane administration to block somatic and cardiovascular responses to skin incision in children and adults. Anesthesiology 2002;97:1142–5.

15. O’Leary E, Hubbard K, Tormey W, Cunningham AJ. Laparoscopic cholecystectomy: hemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth 1996;76:640–4.

16. Le Roith D, Barn H, Nyska M, Glick SM. The effect of abdominal pressure on plasma antidiuretic hormone levels in the dog. J Surg Res 1982;32:65–9.

17. Punnonen R, Viinama¨ki O. Vasopressin release during laparoscopy: role of increased intra-abdominal pressure. Lancet 1982;1:175–6.

18. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy a critical assessment of the evidence. Anesthesiology 2006;104:835–46.

19. Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, Chauvin M. Remifentanyl-induced postoperative hyperalgesia and its prevention with small-dose ketamine. Anesthesiology 2005;103:147–55.

20. Shin SW, Cho AR, Lee HJ, Kim HJ, Byeon GJ, Yoon JW, Kim KH, Kwon JY. Maintenance anaesthetics during remifentanyl-based anaesthesia might affect postoperative pain control after breast cancer surgery. Br J Anaesth 2010;105:661–7.

21. Van Delden PG, Houweling PL, Bencini AF, Ephraim EP, Frietman RC, Niekerk J, van Stolk MA, Verheijen R, Wajer OJM, Mulder PGH. Remifentanyl-sevoflurane anaesthesia for laparoscopic cholecystectomy: comparison of three dose regimens. Anaesthesia 2002;57:212-217.

22. Katoh T, Suguro Y, Ikeda T, Kazama T, Ikeda K. Influence of age on awakening concentrations of sevoflurane and isoflurane. Anesth Analg 1993;76:348-52.

23. Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med 2008;358:1097-108.

24. Bisgaard T. Analgesic treatment after laparoscopic cholecystectomy a critical assessment of the evidence. Anesthesiology 2006;104:835–46.

25. PROSPECT: procedure-specific postoperative pain management, www.postoppain.org (accesado el 25 de octubre 2010).

26. Simoni RF, Arantes PAMS, Borega RS, Pereira SDC. Continuous infusion of remifentanyl versus sufentanyl in videolaparoscopic surgeries. A comparative study. Rev Bras Anestesiol 2008;58:193-201.

27. Gaszynski TM, Strzelczyk JM, Gaszynski WP. Post-anesthesia recovery after infusion of propofol with remifentanyl or alfentanyl or fentanyl in morbidly obese patients. Obes Surg 2004;14:498-503.