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Modulation of Remifentanil-Induced Postoperative Hyperalgesia and Tolerance by Subhypnotic Doses of Propofol

Author: LiDongHua
Tutor: ChenYanPing
School: Central South University
Course: Anesthesia
Keywords: Remifentanil Asian sleep dose of propofol Hyperalgesia Opioid tolerance Fentanyl
CLC: R614
Type: Master's thesis
Year: 2008
Downloads: 107
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Abstract


Purposes: ① intraoperative application of a relatively large dose of remifentanil-induced hyperalgesia; ② observed the Asian sleep dose of propofol on general anesthesia, intraoperative infusion of remifentanil-induced postoperative hyperalgesia inhibition. Methods: under general anesthesia 60 cases of abdominal surgery, ASAI to level III, were randomly divided into three groups of 20 each. Processed as follows: three groups of patients induction of anesthesia given microphone midazolam 0.1mg/kg atracurium 0.5mg/kg, the remifentanil 1.0μg/kg after endotracheal intubation. Surgery to maintain: (1) group I remifentanil 0.1μg.kg -1 . Min -1 speed infusion, adjusted according to the depth of anesthesia isoflurane concentration; ② group II isoflurane concentration of 0.5 MAC remifentanil speed adjusted according to the depth of anesthesia. (3) group III isoflurane concentration of 0.5 MAC, to stop remifentanil anesthesia depth adjustment speed of remifentanil 1.0μg.kg -1 min - 1 rate of intravenous infusion of propofol until 15 minutes after extubation. Three groups before the end of surgery 15 minutes stop isoflurane and remifentanil, stop anesthetics according to the patient's mean arterial pressure, systolic blood pressure, heart rate, and after extubation pain score fentanyl to deepen anesthesia or town pain. Three groups of patients remifentanil, pain scores were recorded, and 24h after application of fentanyl. Results: group II and group III intraoperative remifentanil average pump fluence (0.26 ± 0.17) μg.kg of -1 min -1 and (0.27 ± 0.28) μg.kg -1 min -1 , no significant difference between the two, than those in group I (0.10 ± 0.00) μg.kg -1 . min -1 (P <0.05). Three groups perioperative hemodynamic stable, no significant difference between the three. Recovery of consciousness, no statistical difference in the incidence rate of extubation time and postoperative adverse reactions. Group II patients between 30-4 minutes after extubation VAS score higher than group Ⅰ (P <0.05), between 15-4 minutes after extubation than the III group (P <0.05); II group stopped remifentanil first time fentanyl Ⅰ, Ⅲ group was significantly (P <0.05) in advance, and after 24 hours fentanyl total (P <0.05) were significantly more likely. Conclusion: (1) surgery is relatively large doses of remifentanil caused postoperative pain and postoperative analgesic fentanyl, suggesting that remifentanil can cause postoperative hyperalgesia. (2) stop remifentanil application sub-sleep dose of propofol can reduce postoperative pain scores, and reduce postoperative fentanyl, Tip Asia sleep dose of propofol relieve opioid induced by remifentanil tolerance and hyperalgesia.

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CLC: > Medicine, health > Surgery > Surgical operation > Anesthesiology
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