期刊
JOURNAL OF ANESTHESIA
卷 28, 期 3, 页码 334-340出版社
SPRINGER JAPAN KK
DOI: 10.1007/s00540-013-1738-x
关键词
Opioids; Intravenous; Remifentanil; Laparoscopic surgery; Thoracic epidural anesthesia; Stress responses; Pneumoperitoneum
Although 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. We 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 mu g/kg/min [low-dose (LD) group], or 1.0 mu g/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. All 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. Notwithstanding 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.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据