medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2006, Number 1

<< Back Next >>

An Med Asoc Med Hosp ABC 2006; 51 (1)

Hemodynamic changes between remifentanil versus fentanyl during laparoscopic cholecystectomy

Gutiérrez A, Álvarez I, Martínez E, Alonso A, García T, Espíritu S, Olivares H

Language: Spanish
References: 28
Page: 18-23
PDF size: 97.95 Kb.


ABSTRACT

Once compared with open cholecystectomy laparoscopic surgery offers many advantages, nevertheless this procedure exposes the surgical field by means of increased intraabdominal pressure with carbon dioxide which allows catecholamine release. Remifentanil μ receptor agonist, characterized by fast onset, absence of accumulation and fast elimination seems the ideal analgesic for intraoperative pain control, as well as a diminution of the secondary hemodynamic effects due to intraabdominal pressure increase, in addition to allow the quick recovery without risk of respiratory depression. Methods: Thirty patients ASA I–II undergoing laparoscopic cholecystectomy were randomized in two groups: 1) Remifentanil infusion and, 2) Fentanyl infusion both under Desflurane anaesthesia. In operating room heart rate, noninvasive arterial pressure, pulse oximetry, end tidal carbon dioxide and minimum alveolar concentration were recorded during pneumoperitoneum and during their stay in postanesthetic care unit until discharge. Results: We found significant statistical difference (p ‹ 0.05) in heart rate, mean arterial pressure and minimum alveolar concentration in Remifentanil group. The total dose of morphine in Remifentanil group was greater; nevertheless they did not present respiratory depression. Conclusions: Data suggests greater hemodynamic control during pneumoperitoneum assuring quick anaesthetic emersion offering greater security for the morphine administration in postoperative pain control.


REFERENCES

  1. Koivusalo AM, Lindgren L. Effects of carbon dioxide pneumoperitoneum for laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2000; 44: 834-841.

  2. Myre K, Raeder J, Rostrup M, Buanes T, Stokland O. Catecholamine release during laparoscopic fundoplication with high and low doses of remifentanil. Acta Anaesthesiol Scand 2003; 47 (3): 267-273.

  3. Grundmann U, Silomon M, Bach F, Becker S, Bauer M, Larsen B, Kleinschmidt S. Recovery profile and side effects of remifentanil-based anaesthesia with desflurane or propofol for laparoscopic cholecystectomy. Acta Anaesthesiol Scand 2001; 45 (3): 320-326.

  4. De Castro V, Godet G, Mencia G, Raux M, Coriat P. Targetcontrolled infusion for remifentanil in vascular patients improves hemodynamics and decreases Remifentanil requirement. Anesth Analg 2003; 96: 33-38.

  5. Loop T, Priebe HJ. Recovery after anesthesia with remifentanil combined with propofol, desflurane or sevoflurane for otorhinolaryngeal surgery. Anesth Analg 2000; 91: 123-129.

  6. Servin FS. Remifentanil: An update. Curr Opin Anaesthesiol 2003; 16: 367-372.

  7. Noseir RK, Ficke DJ, Kundu A, Arain S. Sympathetic and vascular consequences from remifentanil in humans. Anesth Analg 2003; 96: 1645-1650.

  8. Albertini A, Casati A, Deni F et al. Clinical comparison of either small dosses of fentanyl or remifentanil for blunting cardiovascular changes induced by tracheal intubation. Minerva Anestesiol 2000; 66: 691-696.

  9. Hanouz JL, Yvon A, Guesne G, Eustratiades C, Babatasi G, Rouet R, Ducouret P, Khayat A, Bricard H, Gérard JL. The in vitro effects of Remifentanil, Sufentanil, Fentanyl and Sulfentanil on isolated human right atria. Anesth Analg 2001; 93: 543-549.

  10. Hirvonen EA, Nuutinen LS, Vuolteenaho O. Hormonal responses and cardiac filling pressures in head-up or headdown position and pneumoperitoneum in patients undergoing operative laparoscopy. Br J Anaesth 1997; 78: 128-133.

  11. Mertens MJ, Olofsen E, Englbers FHM et al. Propofol reduces perioperative remifentanil requirements in a synergistic manner: Response surface modeling of perioperative remifentanil-propofol interactions. Anesthesiology 2003; 99: 347-359.

  12. Harris S, Ballantyne G, Luther M, Perrino A. Alterations of cardiovascular performance during laparoscopic colectomy: A combined hemodynamic and echocardiographic analysis. Anesth Analg 1996; 83: 482-487.

  13. Beers R, Calimlim R, Uddoh E, Esposito BF, Camporesi EM. A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg 2000; 91: 1420-1425.

  14. Hoymork SC, Raeder J, Grimsmo B, Steen PA. Bispectral index, serum drug concentrations and emergence associated with individually adjusted target-controlled infusions of remifentanil and propofol for laparoscopic surgery. Br J of Anaesth 2003; 91 (6): 773-780.

  15. Albertini A, Casati A, Federica L et al. The effect-site concentration of Remifentanil blunting cardiovascular responses to tracheal intubation and skin incision during bispectral index-guided propofol anesthesia. Anesth Analg 2005; 101: 125-130.

  16. Larsen B, Seitz A, Larsen R. Recovery of cognitive function alter remifentanil-propofol anesthesia: A comparison with desflurane and sevoflurane anesthesia. Anesth Analg 2000; 90: 168-174.

  17. Muñoz HR, Guerrero ME, Brandes V, Cortinez LI. Effect of timing of morphine administration during remifentanil-based anaesthesia on early recovery from anaesthesia and postoperative pain. Br J Anaesth 2002; 88 (6): 814-818.

  18. Kochs E, Côté D, Deruyck L, Rauhala V, Puig M, Polati E et al. Postoperative pain management and recovery after remifentanil-based anaesthesia with isoflurane of propofol for major abdominal surgery. Br J Anaesth 2000; 84: 169-173.

  19. Fletcher D, Pinaud M, Scherpereel P, Clyti N, Chauvin M. The efficacy of intravenous 0.15 versus 0.25 mg/kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery. Anesth Analg 2000; 90: 666-671.

  20. Albrecht S, Fechner J, Geisslinger G, Maass AB, Upadhyaya B, Moecke H, Haigh C, Schuttler J. Postoperative pain control following remifentanil-based anaesthesia for major abdominal surgery. Anaesthesia 2000; 55: 315-322.

  21. Guignard B, Bossard AE, Coste C et al. Acute opioid tolerance: Intraoperative remifentanil increases postoperative pain and morphine requirement. Anesthesiology 2000; 93: 409-417.

  22. Guignard B, Coste C, Costes H et al. Supplementing desflurane-remifentanil anesthesia with small-dose ketamine reduces perioperative opioid analgesic requirements. Anesth Analg 2002; 95: 103-108.

  23. Joly V, Richebe P, Guignard B, Fletcher D, Maurette P, Sessler DI, Chauvin M. Remifentanil induced postoperative hyperalgesia and its prevention with small dose ketamine. Anesthesiology 2005; 103: 147-155.

  24. Lorenz H, Kolbitsch C, Hinteregger M, Bauer P, Spiegel M, Luger TJ, Schmidauer C, Streif W, Pfeiffer P, Benzer A. Remifentanil and nitrous oxide reduce changes in cerebral blood flow velocity in the middle cerebral artery caused by pain. Br J Anaesth 2003; 90 (3): 296-299.

  25. Jaksch W, Lang S, Reichhalter R et al. Perioperative smalldose S (+)-ketamine has no incremental benefical effects on postoperative pain when standard-practice opioid infusions are used. Anesth Analg 2002; 94: 981-986.

  26. Guntz E, Dumont H, Roussel C, Gall D, Dufrasne F et al. Effects of remifentanil on N-methyl-d-aspartate receptor. Anesthesiology 2005; 102: 1235-1241.

  27. Lee LHY, Irwin M, Lui S. Intraoperative remifentanil infusion does not increase postoperative opioid consumption compared with 70% nitrous oxide. Anesthesiology 2005; 102: 398-402.

  28. Hood DD, Curry R, Eisenach JC: Intravenous remifentanil produces withdrawal hyperalgesia in volunteers with capsaicin-induced hyperalgesia. Anesth Analg 2003; 97: 810-815.




2020     |     www.medigraphic.com