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Association of Target-controlled Infusion of Equivalent Doses of Opioids with Stress Response During Induction of Anesthesia

Author: LiChunWei
Tutor: ZhangWei
School: Zhengzhou University
Course: Anesthesiology
Keywords: Opioids induction anesthesia Target control infusion
CLC: R614
Type: Master's thesis
Year: 2012
Downloads: 7
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Abstract

Background and ObjectiveThe stress response is non-specific defense reaction of the body caused by strong nociceptive stimulation. The body is more prone to have cardiovascular dysfunction during anesthesia because of the stress response even serious complications. During induction of general anesthesia, the sympathetic-adrenal nervous system can be excited by strong stimulation of endotracheal intubation. That lead to a substantial increase in catecholamine secretion in the body which can cause vital organs such as the heart, brain and other serious complications or accidents.Previous studies have shown that opioids may reduce the stress response by activating opioid receptors to reduce noxious stimuli. Opioids may also through the coordination of the release or intake of the hormone of the adrenal medulla to reduce the stress response. Thereby reducing the stimulus from the throat to reduce the strength of the stress response of the body, and keep the hemodynamically stable.The purpose of this study is to observe the impact of target-controlled infusion of equivalent doses of opioids drugs on the stress response, to investigate the appropriate drug opioid and target-controlled infusion drug concentration during anesthesia. The present study provides an important clinical evidence for the rational use of opioids. Materials and MethodsSubjectsTotal ninety subjects, aged18-60yr, within±20%of ideal body weight, and having an American Society of Anesthesiologists (ASA) physical status of I or II, undergoing selective surgery with general anesthesia were enrolled. Exclusion criteria included the following:known history of cardiovascular disease or cerebrovascular disease, hypertension, hepatic or renal dysfunction, allergic asthma, long-term use of opioid or antipsychotic drugs, recent use of monoamine oxidase inhibitors.GroupsNinety patients were randomly divided into three groups:group A, group B and group C, n=30. Each group was randomly divided into three subgroups by different target-controlled drugs. F1subgroups:plasma concentration of3ng/ml fentanyl, R1subgroups:plasma concentration of3ng/ml remifentanil, S1subgroups:plasma concentration of0.3ng/ml sufentanil. F2subgroups:plasma concentration of5ng/ml fentanyl, R2subgroups:plasma concentration of5ng/ml remifentanil, S2subgroups: plasma concentration of0.5ng/ml sufentanil. F3subgroup:plasma concentration of7ng/ml fentanyl, R3subgroups:plasma concentration of7ng/ml remifentanil, S3subgroups:plasma concentration of0.7ng/ml sufentanil, n=10. Records the heart rate (HR), mean arterial pressure (MAP) and bispectral index (BIS) values at basis time (TO), before tracheal intubation (T1), immediately after endotracheal intubation (T2), one minute after endotracheal intubation (T3), two minutes after endotracheal intubation (T4), five minutes after endotracheal intubation (T5), ten minutes after endotracheal intubation (T6).Statistical analysisData were presented as mean±S.D. Statistical comparison of data were made using SPSS software (Version17.0;SPSS,Chicago,IL,USA) for both a one-way analysis of variance and repeated-measures ANOVA, Chi-squared test was used in enumeration data. A value of P<0.05was considered statistically significant.Results1. The general situationAmong the groups, there were no difference in mean arterial pressure(MAP), heart rate(HR) and BIS value of preoperative (P>0.05).2. Hemodynamic changesIn group A:Compared with T0, MAP raised and HR increased in group F1at T2、T3、T4, in group R1at T2、T3and in group S1at T2(P<0.05). In group B: Compared with T0, MAP raised and HR increased in group F2at T2(P<0.05). In group C:Compared with T0, MAP reduced and HR slow down in group F3at T1-T4、in group R3at T1-T3and in group S3at T1(P<0.05).In group F:Compared with F2, MAP raised and HR increased in group F1at T2、T3、T4(P<0.05),while MAP reduced and HR slow down in group F3at T1-T4(P<0.05).In group R:Compared with R2, MAP raised and HR increased in group R1at T2、T3(P<0.05),while MAP reduced and HR slow down in group R3at T1-T3(P<0.05).In group S:Compared with S2, MAP raised and HR increased in group S1at T2(P<0.05),while MAP reduced and HR slow down in group S3at T1、T2(P <0.05).3. The comparison of BISCompared with T0, BIS was reduced at different time points in each group. The range of BIS changed above45to55in group F1at T1-T4,in group S1at T2-T3and in group F2at T3. The range of BIS changed below45to55in group F3at T1、 T4-6,in group R3at T1、T5、T6and in group S3at T1、T6. The range of BIS changed between45to55at different time points in group F2、R2、S2. Conclusions1. Target-controlled infusion of equivalent dose fentanyl, remifentanil, sufentanil during the General anesthesia induction period,to stress reaction,sufentanil is the best, remifentanil is the second, and fentanyl is poor.2. The best target concentration of fentanyl, remifentanil, sufentanil is5ng/mL,5ng/mL,0.5ng/mL respectively during general anesthesia induction period.3. Fentanyl reduced the blood pressure strongly and fentanyl, remifentanil slow down the heart rate strongly when the target concentration is7ng/mL; sufentanil in the blood pressure and heart rate effect is weak when the target concentration is7ng/mL.

Association of Target-controlled Infusion of Equivalent Doses of Opioids with Stress Response During Induction of Anesthesia

Abstract

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