High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy
High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy
复制标题
高剂量瑞芬太尼抑制腹腔镜结肠切除术中与气腹相关的应激反应
DOI：
10.1007/s00540-013-1738-x
复制
发表时间：
2014
影响因子：
2.8
通讯作者：
Y. Kamiyama
中科院分区：
文献类型：
--
作者：
Koji Watanabe;K. Kashiwagi;Tomonari Kamiyama;Makiko Yamamoto;M. Fukunaga;E. Inada;Y. Kamiyama
目的腹腔镜手术虽然创伤小，但其产生的应激反应与传统开腹手术相似。硬膜外麻醉和瑞芬太尼静脉注射，联合全身麻醉，在腹腔镜手术中提供稳定的血流动力学。然而，尚未阐明硬膜外麻醉和瑞芬太尼是否与自主神经和神经内分泌应激反应的抑制有关。本研究旨在阐明胸段硬膜外麻醉（TEA）或瑞芬太尼是否抑制腹腔镜手术中的应激反应。方法我们将60例接受腹腔镜结肠切除术的患者分为三组，分别用40%氧气-空气-七氟醚加TEA或瑞芬太尼麻醉。低剂量（LD）组持续输注瑞芬太尼0.25 μg/kg/min，高剂量（HD）组持续输注瑞芬太尼1.0 μg/kg/min。促肾上腺皮质激素（ACTH），皮质醇，抗利尿激素（ADH），和儿茶酚胺的血浆浓度测定麻醉诱导前立即，30和90分钟后开始的气腹。ResultsAll groups显示在麻醉过程中血流动力学没有显着变化。与TEA相比，高剂量和低剂量瑞芬太尼均显著抑制了气腹期间ACTH、ADH和皮质醇的升高。血浆肾上腺素在任何组的气腹期间均未显示出显著变化。与TEA相比，低剂量瑞芬太尼产生显着更高的血浆浓度的去甲肾上腺素和多巴胺在气腹during conclusionsummarized相似的血流动力学反应，在所有组中，只有高剂量瑞芬太尼抑制交感神经反应和下丘脑-垂体-肾上腺轴。这一结果表明，这三种麻醉方案中，大剂量瑞芬太尼似乎最适合腹腔镜手术。
PurposeAlthough laparoscopic surgery is minimally invasive, it produces stress responses to an extent similar to that of conventional laparotomy. Both epidural anesthesia and remifentanil intravenously (i.v.), combined with general anesthesia, provide stable hemodynamics during laparoscopic surgery. However, it has not been elucidated whether epidural anesthesia and remifentanil are associated with suppression of autonomic and neuroendocrine stress responses. This study aimed to clarify whether thoracic epidural anesthesia (TEA) or remifentanil suppresses stress responses during laparoscopic surgery.MethodsWe assigned 60 patients undergoing laparoscopic colectomy to three groups anesthetized with 40 % oxygen–air–sevoflurane plus either TEA (TEA group), continuous infusion of remifentanil 0.25 μg/kg/min [low-dose (LD) group], or 1.0 μg/kg/min [high-dose (HD) group] (n= 20 each group). Plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol, antidiuretic hormone (ADH), and catecholamines were measured immediately before anesthesia induction, and 30 and 90 min after the start of pneumoperitoneum.ResultsAll groups showed no significant changes in hemodynamics during the course of anesthesia. Compared with TEA, both high-dose and low-dose remifentanil significantly suppressed increases in ACTH, ADH, and cortisol during pneumoperitoneum. Plasma adrenaline showed no significant changes during pneumoperitoneum in any group. Compared with TEA, low-dose remifentanil produced significantly higher plasma concentrations of noradrenaline and dopamine during pneumoperitoneum.ConclusionNotwithstanding similar hemodynamic responses in all groups, only high-dose remifentanil suppressed both sympathetic responses and the hypothalamus–pituitary–adrenal axis. This result indicates that of these three anesthesia regimens, high-dose remifentanil seems most suited for laparoscopic surgery.