Effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing resection of rectal carcinoma

BACKGROUND Rectal carcinoma(RC)treatment primarily involves laparoscopic surgery,which may induce significant hemodynamic changes and weaken immune function.Certain anesthetic approaches using opioid drugs(including remifentanil and sufentanil)pose risks,such as hypotension.AIM To determine the effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing RC resection.METHODS A total of 211 patients one hundred and four patients with RC treated at the First Affiliated Hospital of Dalian Medical University between November 2018 and November 2022 were retrospectively analyzed.Among them,the remifentanil group included 45 patients receiving remifentanil with propofol anesthesia and the sufentanil group included 59 patients receiving sufentanil with propofol anesthesia.Changes in the hemodynamic index,oxidative stress index,general data,consumption of remifentanil,and use of vasoactive drugs were compared.The incidences of adverse reactions were calculated.RESULTS The two groups did not significantly differ in terms of operation,anesthesia,and extubation times(P>0.05).At 1 min after intubation,the sufentanil group showed a notably higher heart rate,systolic blood pressure(SBP),diastolic blood pressure,and mean arterial pressure(MAP)compared with the remifentanil group(P<0.05),whereas the sufentanil group showed a notably higher SBP and MAP compared with the remifentanil group at 5 min after pneumoperitoneum(P<0.05).Thirty minutes after surgery,the remifentanil group showed significantly lower plasma cortisol,noradrenaline,and glucose levels than the sufentanil group(P<0.001).The remifentanil group consumed significantly less remifentanil than the sufentanil group(P<0.05),and the adoption frequency of ephedrine was lower in the remifentanil group than that in the sufentanil group(P<0.05).The incidence of hypotension was notably higher in the sufentanil group than that in the remifentanil group(P<0.05).CONCLUSION Remifentanil combined with propofol can improve hemodynamics and relieve oxidative stress in patients undergoing RC resection.

Effects of Remifentanil Pretreatment on Inflammatory Response in Rats with Acute Cerebral Ischemia Injury

[Objectives]This study was conducted to investigate the effects of remifentanil pretreatment on inflammatory factors in rats with acute cerebral ischemia.[Methods]Sixty SD rats were randomly divided into the normal control group,sham operation group,ischemic brain injury group,and remifentanil pretreatment group.Except the normal control group,each group was divided into three subgroups(six in each group)according to the sampling time points of 6,12 and 24 h after execution.After modeling,the rats were scored for neurological deficit,and observed for pathological changes of neurons in the brain tissue by HE staining and the brain infarct volume by TTC staining,and the expression levels of TNF-α,IL-6 and IL-8 were detected by RT-PCR.[Results]HE staining:No significant changes were observed in the pathological morphology of the brain tissue in the blank group and sham operation group;and the neuronal structure of rats in the acute cerebral ischemia group was obviously damaged,and the neuronal damage in the remifentanil pretreatment group was less than that in the acute cerebral ischemia group at each time point.TTC staining:The gray brain infarct area in the remifentanil pretreatment group was significantly smaller than that in the cerebral ischemia group(P<0.05).RT-PCR detection results:The expression levels of TNF-α,IL-6 and IL-8 in the blank group and sham surgery group did not show significant changes at different times(P>0.05);and compared with the cerebral ischemia group,the expression levels of TNF-α,IL-6,and IL-8 in the remifentanil pretreatment group were significantly reduced at all time points(P<0.05).[Conclusions]Remifentanil pretreatment could protect the brain by reducing the expression of inflammatory factors after cerebral ischemia injury.

新型超短效镇痛药——remifentanil

remifentanil具有可被组织及血液中的非特异性酯酶快速降解、清除率快、分布容积小、半衰期短、镇痛效能强、对呼吸循环肝肾功能影响小等特点,临床应用广泛。

右美托咪定复合Remifentanil在面部整形手术非插管静脉全麻中的应用效果及作用研究

研究右美托咪定复合Remifentanil在面部整形手术非插管静脉全麻中的应用效果及作用。方法: 68例面部整形手术患者均为我院2019年08月-2021年08月收治于2019.08-2021.08,随机分为对照组、观察组,分别施以丙泊酚复合Remifentanil麻醉、右美托咪定复合Remifentanil麻醉。结果:两组心电监护指标[MAP(平均动脉压)、HR(心率)、Paw(气道压)、PETCO2(呼气末二氧化碳分压)、BIS(脑电双频指数)]以及应激反应指标[COR(皮质醇)、CRP(C-反应蛋白)、DBP(舒张压)、SBP(收缩压)、GLU(血糖)]组间、时间点、交互作用均有统计学差异(P<0.05)。观察组术后不同时间段、不同状态下的疼痛评分、不良反应发生率均低于对照组,苏醒、清醒时间短于对照组(P<0.05)。结论:在面部整形手术麻醉中应用右美托咪定复合Remifentanil麻醉效果显著,应用价值高。

Propofol and remifentanil at moderate and high concentrations affect proliferation and differentiation of neural stem/progenitor cells

Propofol and remifentanil alter intracellular Ca^2＋ concentration （[Ca^2＋]i） in neural stem/progen-itor cells by activating γ-aminobutyric acid type A receptors and by reducing testosterone levels. However, whether this process affects neural stem/progenitor cell proliferation and differenti-ation remains unknown. In the present study, we applied propofol and remifentanil, alone or in combination, at low, moderate or high concentrations （1, 2–2.5 and 4–5 times the clinically effective blood drug concentration）, to neural stem/progenitor cells from the hippocampi of newborn rat pups. Low concentrations of propofol, remifentanil or both had no noticeable effect on cell proliferation or differentiation; however, moderate and high concentrations of propofol and/or remifentanil markedly suppressed neural stem/progenitor cell proliferation and differen-tiation, and induced a decrease in [Ca^2＋]i during the initial stage of neural stem/progenitor cell differentiation. We therefore propose that propofol and remifentanil interfere with the prolifer-ation and differentiation of neural stem/progenitor cells by altering [Ca^2＋]i. Our ifndings suggest that propofol and/or remifentanil should be used with caution in pediatric anesthesia.

Effect of Electro-acupuncture Stimulation of Ximen(PC4) and Neiguan(PC6) on Remifentanil-induced Breakthrough Pain Following Thoracal Esophagectomy

The clinical analgesic effect of electro-acupuncture（EA） stimulation（EAS） on breakthrough pain induced by remifentanil in patients undergoing radical thoracic esophagectomy, and the mechanisms were assessed. Sixty patients（ASAⅢ） scheduled for elective radical esophagectomy were randomized into three groups： group A（control） receiving a general anesthesia only; group B（sham） given EA needles at PC4（Ximen） and PC6（Neiguan） but no stimulation; and group C（EAS） electrically given EAS of the ipsilateral PC4 and PC6 throughout the surgery. The EAS consisting of a disperse-dense wave with a low frequency of 2 Hz and a high frequency of 20 Hz, was performed 30 min prior to induction of general anesthesia and continued through the surgery. At the emergence, sufentanil infusion was given for postoperative analgesia with loading dose of 7.5 μg, followed by a continuous infusion of 2.25 μg/h. The patient self-administration of sufentanil was 0.75 μg with a lockout of 15 min as needed. Additional breakthrough pain was treated with dezocine（5 mg） intravenously at the patient＇s request. Blood samples were collected before（T1）, 2 h（T2）, 24 h（T3）, and 48 h（T4） after operation to measure the plasma β-EP, PGE2, and 5-HT. The operative time, the total dose of sufentanil and the dose of self-administration, and the rescue doses of dezocine were recorded. Visual Analogue Scale（VAS） scores at 2, 12, 24 and 48 h postoperatively and the incidence of apnea and severe hypotension were recorded. The results showed that the gender, age, weight, operative time and remifentanil consumption were comparable among 3 groups. Patients in EAS group had the lowest VAS scores postoperatively among the three groups（P〈0.05）. The total dose of sufentanil was 115±6.0 μg in EAS group, significantly lower than that in control（134.3±5.9 μg） and sham（133.5±7.0 μg） groups. Similarly, the rescue dose of dezocine was the least in EAS group（P〈0.05） among the three groups. Plasma β-EP levels in EAS group at T3（176.90±45.73） and T4（162.96±35.00 pg/mL） were significantly higher than those in control（132.33±36.75 and 128.79±41.24 pg/mL） and sham（136.56±45.80 and 129.85±36.14 pg/mL） groups, P〈0.05 for all. EAS could decrease the release of PGE2. Plasma PGE2 levels in EAS group at T2 and T3（41±5 and 40±5 pg/mL respectively） were significantly lower than those in control（64±5 and 62±7 pg/mL） and sham（66±6 and 62±6 pg/mL） groups. Plasma 5-HT levels in EAS group at T2（133.66±40.85） and T3（154.66±52.49 ng/mL） were significantly lower than those in control（168.33±56.94 and 225.28±82.03） and sham（164.54±47.53 and 217.74±76.45 ng/mL） groups. For intra-group comparison, plasma 5-HT and PGE2 levels in control and sham groups at T2 and T3, and β-EP in EAS group at T3 and T4 were significantly higher than those at T1（P〈0.05）; PGE2 and 5-HT levels in EAS group showed no significant difference among the different time points（P〉0.05）. No apnea or severe hypotension was observed in any group. It was concluded that intraoperative ipsilateral EAS at PC4 and PC6 provides effective postoperative analgesia for patients undergoing radical esophagectomy with remifentanil anesthesia and significantly decrease requirement for parental narcotics. The underlying mechanism may be related to stimulation of the release of endogenous β-EP and inhibition of inflammatory mediators（5-HT and PGE2）.

Comparative induction of controlled circulation by magnesium and remifentanil in spine surgery

AIM: To evaluate the efficacy of magnesium sulfate(MGS) in comparison with remifentanil for induction of relative hypotension in posterior fusion of spine(PSF).METHODS: In this randomized clinical trial, 40 patients with the American Society of Anesthesiologists Ⅰ and Ⅱ physical status undergoing lumbar PSF were randomized to receive remifentanil(REM) 0.15 μg/kg or MGS 50 mg/kg for controlled hypotension. The administering anesthesiologist was blinded to the medication. Continuous infusion was maintained at a fixed volume rate to deliver precalculated doses of either study drugs. All other aspects of anesthesia and surgery were similar in the two groups. The target mean arterial pressure(MAP) range used in this study was 60-70 mm Hg. In the course of surgery, the hemodynamic variables, volumeof blood loss, urine output, fluid intake and surgeon's satisfaction were recorded. Data was analyzed with SPSS version 13.0 and P values less than 0.05 were considered significant.RESULTS: Twenty patients in the MGS group and 19 patients in the REM group were studied. There was no difference between the two groups in the hemodynamic variables, blood loss, urine output, fluid requirement and surgeon's satisfaction for exposure. The target MAP was achieved in 75% of Mg and 58% of remifentanil groups. Although a higher number of patients in the REM group required nitroglycerin(42.1%) to reach the target MAP than those in the MGS group(25%), this difference was not statistically significant(P = 0.32).CONCLUSION: Our findings showed that in patients undergoing lumbar PSF surgery, remifentanil and MGS have a similar hypotensive effect and comparable amount of blood loss without any significant adverse effects.

The Effects of Glucose Load on Catabolism during Remifentanil-Based Anesthesia in Patients with Diabetes Mellitus: A Prospective Randomized Trial

Background: General anesthesia using remifentanil may suppress the unwanted metabolic changes caused by surgical stress including hyperglycemia and ketogenesis. Surgery-related changes in catabolism can be attenuated with low-dose glucose load, without causing hyperglycemia. However, the impact of glucose load in diabetic patients during surgery is unknown. In this study, we investigated the effect of glucose load on catabolism during remifentanil-based anesthesia in patients with diabetes mellitus. Methods: Twenty-nine patients with diabetes mellitus undergoing elective surgery were randomly assigned to receive a glucose load (1.5 mg/kg/min) or not. Plasma levels of glucose, insulin, cortisol, dopamine, adrenaline, noradrenaline, acetoacetic acid, free fatty acid, ketone bodies, 3-hydroxybutyric acid, and 3-methylhistidine/creatinine, a marker of protein catabolism were measured at the start of surgery and 3 h after the start of surgery. Results: Glucose and insulin levels were significantly higher in patients who received a glucose load than in those who did not. Cortisol levels decreased at 3 h after the start of surgery in both groups whereas the levels of catecholamines were unchanged. Acetoacetic acid and total ketone body levels were significantly lower in patients given a glucose load than in those who were not 3 h after the start of surgery. The difference in the 3 methylhistidine/creatinine ratio between the two groups was not significant. Conclusions: The infusion of glucose suppressed lipid catabolism in diabetic patients under remifentanil-based anesthesia during surgery. Our study also suggests that in patients with diabetes mellitus, protein sparing is inhibited by remifentanil-based anesthesia, regardless of the glucose load. Trial registration: the University Hospital Medical Information Network identifier: UMIN000010914.

Comparison of Hemodynamic Responses Associated with Tracheal Intubation Under Various Induction Doses of Remifentanil and Propofol

.Background: The optimal dose of propofol and remifentanil induction to minimize the cardiovascular response associated with tracheal intubation may exist. We investigated the cardiovascular response associated with tracheal intubation when various continuous induction doses of remifentanil in combination with propofol were used. Methods: Seventy- five patients were randomly allocated into 1 of 3 groups: the R-0.4 P-1 group (remifentanil 0.4 μg/kg/min and propofol 1 mg/kg);the R-0.5 P-1 group (remifentanil 0.5 μg/kg/min and propofol 1 mg/kg);and the R-0.4 P-2 group (remifentanil 0.4 μg/kg/min and propofol 2 mg/kg). One minute after remifentanil infusion commenced, a bolus of propofol was injected. Rocuronium 1 mg/kg was administered 1 min after propofol injection following loss of consciousness. Controlled ventilation was then performed for 2 min, and the trachea was intubated 4 min after the start of the remifentanil infusion. The infusion rate of remifentanil was decreased to 0.1 μg/kg/min after intubation. Blood pressure (BP) and heart rate (HR) were measured during this period until 5 min after tracheal intubation. Results: The changes in BP response due to tracheal intubation in the R-0.4 P-1 group were greater than those in the other 2 groups, whereas the HR responses to tracheal intubation were similar among the 3 groups. Conclusion: The combination of remifentanil 0.4 μg/kg/min and propofol 1 mg/kg led to an exaggerated cardiovascular response to tracheal intubation compared with the other combination groups.

Influence of propofol or etomidate combined with remifentanil in painless gastroscopy on inflammatory stress response

Objective:To study the influence of propofol or etomidate combined with remifentanil in painless gastroscopy on inflammatory stress response.Methods: 117 patients with suspected gastritis who underwent painless gastroscopy in our hospital between July 2015 and August 2016 were divided into propofol group (n=67) and etomidate group (n=50) according to the anesthesia schemes. Propofol group received propofol combined with remifentanil anesthesia, and etomidate group received etomidate combined with remifentanil anesthesia. The differences in serum levels of inflammatory factors, stress hormones and oxidative stress indicators were compared between the two groups before the examination (T0), immediately after the examination (T1) and 15 min after the examination (T2).Results: At T0, there were no significant differences in serum levels of inflammatory factors, stress hormones or oxidative stress indexes between the two groups (P>0.05). At T1 and T2, serum inflammatory factors IL-1, IL-6 and CRP levels of etomidate group were lower than those of propofol group;serum stress hormones Cor, NE and E levels were lower than those of propofol group;serum oxidation indexes AOPPs and LHP levels were lower than those of propofol group while anti-oxidation indexes CAT and SOD levels were higher than those of propofol group (P<0.05). Conclusion: Etomidate for painless gastroscopy is better than propofol in maintaining depth of anesthesia and reducing operation trauma.

Effects of Remifentanil Combined with Gastrodin Injection on Cerebral Oxygen Metabolism and Early Postoperative Cognitive Function in Patients Undergoing Laparoscopic Surgery for Cervical Cancer

Objective Effects of Remifentanil combined with Gastrodin injection on cerebral oxygen metabolism and early postoperative cognitive function in patients undergoing laparoscopic surgery for cervical cancer.Methods 107 cases of laparoscopic cervical carcinoma were randomly divided into observation group(54 cases)and control group(53 cases),the control group received anesthesia induction therapy based on Remifentanil,the observation group was given intravenous Gastrodin injection to 120h after operation on the basis of control group.the brain oxygen metabolism and brain injury related indexes 6h,12h,72h and 120h after operation were observed,and the preoperative cognitive function and postoperative cognitive function of two groups after 6h,1d,3d and 5d were evaluated by using Mini-Mental State Examination(MMSE)test method.Results Compared to the preoperative data,the oxygen saturation of the internal jugular vein(SjvO22)and cerebral oxygen saturation(rSO2)of two groups after 6h of operation was significantly decreased(p<0.05),and the indexes all back to normal after 120h,and observation group’s indexes were higher than that in control group(P<0.05);and the Cerebral arterial-venous oxygen content difference(Da-jvO2)and Cerebral Oxygen extraction rate(CERO2)of two groups after 6h of operation was significantly increased(P<0.05),and the indexes all back to normal after 120h and observation group’s indexes were lower than that in control group(P<0.05);serum neuron specific enolase(NSE)and S100B protein level of two groups after 6h of operation was significantly increased and back to normal after 120h,and observation group’s indexes were lower than that in control group(P<0.05);The MMSE score of 6h,12h,72h and 120h were higher in the observation group than in the control group,and the incidence of postoperative cognitive dysfunction(POCD)was lower than that in the control group(P-<0.05).Conclusion In the anesthesia induction program based on Remifentanil,the use of Gastrodin injection can reduce the incidence of cognitive dysfunction after laparoscopic surgery for cervical cancer,and its mechanism may be related to the improvement of brain metabolism and the reduction of hypoxia injury in neurons of cranial nerves.

Study on the Clinical Effect of Dezocine and Remifentanil Combined with Propofol in Anesthesia for Painless Abortion

Objective:To investigate the anesthetic effect of dezocine and remifentanil combined with propofol in painless artificial abortion.Methods:90 cases in total of painlessinduced abortion 1n our hospital from May 2017to May 2020 were retrospectively analyzed,29cases of propofol anesthesia(group A),29cases of dezocine combined with propofol anesthesia(group B),and 32 cases of remifentanil combined with propofol anesthesia(group C)were compared the anesthesia situation.Resuits:Compared with the cases in group A,the incidence of pain,body movement and sPo,90oat the injection site were lower in group B and group C,the use of propofol was reduced,and the VAS scores were lower when the patients begin to awake,and the efficiency was higher than that in group A(P<0.05);there was no statistic difference in the changes of SBP,DBP and HR index data in the operation time,postoperative awake time,and preoperative,intraoperative and postoperative time points of the three groups(P<0.05).Conclusion:Dezocine and remifentamil combined with propofol for painless artificial abortion anesthesia has more significant effect than propofol anesthesia alone,which can relieve patients'pain and reduce the chance of respiratory depression.

Effect of Dexmedetomidine and Remifentanil on Renal Function in Patients Undergoing Bariatric Surgery

Background and Objectives: In anesthesia for bariatric surgery, alterations occur in several organs, including the kidney. The objective of this study was to compare the effect of dexmedetomidine and remifentanil on the renal function of morbidly obese patients submitted to bariatric surgery. Methods: Sixty-one patients were studied prospectively and divided randomly into two groups: remifentanil (R) and dexmedetomidine (D). Renal function was evaluated in three phases: before anesthesia (M0), after anesthetic induction (M1) and after surgical incision (M2). Plasma concentrations were determined for glucose, antidiuretic hormone, creatinine, urea, sodium, potassium and osmolarity and urinary concentrations for creatinine, urea, sodium, potassium and osmolarity. Results: Significant differences were found between groups for potassium at M1 (p Conclusions: In both groups, the clearance values fell from moments M0 to M2. This result indicates that renal function of obese patients submitted to bariatric surgery presented a physiological response compatible with the effect of anesthetic-surgical stress. In the group D, creatinine and sodium clearances were elevated at M1. Urinary volume was greater at M2. These results are suggestive of better preservation of renal function.

Effects of remifentanil combined with propofol anesthesia on IL-1β, IL-6, TNF-α and hemodynamics in patients with brain surgery

Objective: To observe clinical application of remifentanil combined with propofol anesthesia and fentanyl combined with propofol anesthesia in patients with brain surgery, and analyze the change of hemodynamics and serum IL-1β, IL-6 and TNF-α before and after operation. Methods: A total of 90 cases of patients with brain surgery were randomly divided into control group and observation group according to lottery. The control group was given fentanyl combined with propofol anesthesia and the observation group was given remifentanil combined with propofol anesthesia, other combined anesthetic drug was same in both groups. Hemodynamics of all subjects before tracheal intubation (T1), after tracheal intubation (T2), when shin incision (T3) and when extubation (T4) and serum IL-1β, IL-6 and TNF-α before and after surgery 24 hours were measured. Results: There was no significant difference in hemodynamic indexes of all patients in both groups at T1. At T2, T3 and T4, heart rate (HR) and mean arterial pressure (MAP) of the observation group were significantly lower than those in the control group at same period, however blood oxygen saturation (SpO2) was higher than that in the control group at corresponding period, it was significant difference. At T2, T3 and T4, observation indexes HR and MAP of the control group were significantly higher than those at T1, while SpO2 was significantly lower than T1, there was statistical significant difference. While there was no significant difference in HR, MAP and SpO2 in observation group at T1, T2, T3 and T4. There was no significant differences in serum IL-1β, IL-6 and TNF-α levels between the control group and the observation group before surgery. After 24 h of operation, the levels of IL-1β, IL-6 and TNF-α in both groups were higher than those before operation;Moreover levels of IL-1β, IL-6 and TNF-α in observation group were significantly lower than those in the control group at same period after 24 h of operation it was statistical significant difference. Conclusion: Remifentanil combined with propofol anesthesia was able to maintain hemodynamic stability and reduce concentration of serum inflammatory factors, which was one of the potential effective anesthetic compounds.

Effects of Propofol combined with remifentanil on the levels of MBP,NSE and S100B protein,D-D and inflammatory factors in patients with acute craniocerebral trauma

Objective: To investigate the effects of Propofol combined with remifentanil on serum levels of MBP, NSE and S100B protein, D-D and inflammatory factors in patients with acute craniocerebral trauma. Methods: A total of 100 patients were selected with traumatic brain injury who underwent emergency surgery from August 2014 to May 2017 in our hospital, then randomly divided them into the control group and the experimental group, 50 cases each. The control group received isoflurane combined with remifentanil to maintain anesthesia, and the experimental group received propofol and remifentanil to maintain anesthesia. The inflammatory factors and the levels of MBP, NSE, S100B and D-D in the two groups before and after anesthesia (T0), 1H (T1) and postoperative 1H (T2) were detected and compared. Results: There was no significant difference between the two groups in the levels of TNF-α. The serum level of hs-CRP in two groups of T1, T2 increased significantly, the difference was statistically significant compared with T0, in the experimental group, serum level of hs-CRP at T1 and T2 was significantly higher than the control group, the difference was statistically significant. Conclusion: Propofol combined with remifentanil anesthesia for acute craniocerebral trauma can maintain the balance of inflammatory cytokine levels during the perioperative period, inhibit the elevation of serum MBP, NSE, S100B protein and D-D levels, reduce brain cell damage. It has a good protective effect on brain cells and is worthy of clinical application.

Uncontrolled high blood pressure under total intravenous anesthesia with propofol and remifentanil:A case report

BACKGROUND Although propofol generally reduces blood pressure,rarely,it causes hypertension.However,the mechanism by which propofol increases blood pressure has not been established,and so far,there are only a few reported cases.CASE SUMMARY A 46-year-old woman,diagnosed with thyroid cancer,was administered general anesthesia with propofol and remifentanil for a thyroid lobectomy.An increase in the concentrations of intravenous anesthetics further increased her blood pressure.The blood pressure remained stable when anesthesia was maintained with sevoflurane and remifentanil after the interruption of propofol administration.CONCLUSION We concluded that propofol administration was the cause of increased blood pressure.

Evaluating the Efficacy of Remifentanil-Propofol versus Isoflurane in Reducing Blood Loss with Considering Depth of Anesthesia during Endoscopic Sinus Surgery

Several methods have been suggested to decrease bleeding during surgery, one of which is the usage of hypotensive anesthetic agents. Endoscopic Sinus Surgery (ESS) is one of the surgeries which need a clear field and the amount of bleeding profoundly impacts the ability of surgeons. Current study was designed to evaluate the effect of remifentanil combined with propofol versus Isoflurane on blood loss during ESS and its possible interaction with Depth of Anesthesia. Fifty one patients comprising 15 females and 36 males undergoing ESS were chosen for this study. One group received propofol and remifentanil to induce and maintain anesthesia and the second group received Isoflurane. Mean Arterial Blood Pressure (MAP), Depth of Anesthesia and total blood loss were recorded for the patients of both group. Data were analyzed using t-test, Repeated Measures ANOVA and Pearson’s correlation. P 0.05 was considered statistically significant. Both agents induced hypotension during surgery. No significant difference was observed in total blood loss between two groups. DA was decreased in both groups, but no significant correlation was found between DA and MAP or DA and blood loss. There is no significant difference between remifentanil combined with propofol and Isoflurane in decreasing blood loss during ESS, thus we suggest usage of hypotensive anesthetic agent regardless of its type is ESS.

The use of remifentanil in ex utero intrapartum treatment procedures

Purpose: We propose that using remifentanil in ex utero intrapartum treatment (EXIT) procedures reduces the need for maternal exposure to general anesthesia. Using remifentanil along with spinal anesthesia eliminates the fetal and maternal risks associated with inhalational general anesthesia, allows the mother to be awake, and obviates the need for and costs associated with general anesthesia and a second anesthesia team. Materials and Methods: We performed a retrospective review of all sequential patients undergoing ex utero intrapartum treatment procedure at our hospital from 1/1/2009 to 11/1/2010. All procedures were performed under regional neuraxial analgesia, using nitroglycerine as a tocolytic agent and remifentanil for analgesia. Variables included indication, time to secured fetal airway, complications, estimated blood loss, need for additional anesthetics, participating personnel, and survival. Results: All five of our ex utero intrapartum treatment procedures were successfully completed with combined spinal epidural remifentanil anesthetic. No patient was required additional alternative anesthetic. There were no complications with mother or fetus. Indications for procedure were arthyrogryposis (n = 3), fetal goiter, and micrognathia. Average time to secured airway was 10.25 minutes. Average estimated blood loss was 1010 ml. All five mothers were conscious during their procedure. Conclusions: We report the largest series of ex utero intrapartum treatment procedures performed with remifentanil regional anesthesia. We found that the combined use of nitroglycerin and regional remifentanil anesthesia is a safe alternative to the pediatric otolaryngologist for performing ex utero intrapartum treatment procedures without the risks of general anesthesia, allowing the mother to be awake for the delivery, and reducing the cost of providing care.

Remifentanil Has Sufficient Hypnotic and Amnesic Effect for Induction of Anesthesia by Itself

With a small-dose remifentanil, some patients showed no reaction and did not remember it postoperatively. We, therefore, hypothesized that remifentanil may decrease the level of consciousness and/or exhibit amnesic effect when stimulations are avoided. Thirty-patients were divided into two groups: non-stimulation group and stimulation group. Anesthesia was induced with 1 micro-g·kg?1·min?1 of remifentanil using no additional hypnotic agent. In the non-stimulation group, patients were left free from any stimulation except non-invasive blood pressure monitoring. In the stimulation group, patients were asked to follow verbal commands. The level of consciousness was evaluated with electroencephalogram and BIS-value derived from it. In the non-stimulation group, all patients reached the decreased level of consciousness in 5 minutes. In the stimulation group, however, 14 patients were judged to be still conscious. 10 patients could open their mouth at the 5th minute, but 9 of these 10 patients did not remember it postoperatively. In conclusion, remifentanil, with no additional anesthetics, exhibited hypnotic and amnesic effects when stimulations were kept minimal.

Effects of remifentanil combined with propofol intravenous target controlled anesthesia on inflammatory reaction, oxidative stress and neurotransmitter in patients undergoing surgery in cerebral surgery

Objective:To investigate the effect of remifentanil combined with propofol intravenous target-controlled anesthesia on inflammatory reaction, oxidative stress and neurotransmitter in patients undergoing cerebral surgery.Methods: A total of 86 cases of cerebral surgery patients were divided into control group (n=43) and study group (n=43) based on random lottery method, the patients in the control group was given fentanyl combined with propofol intravenous target controlled anesthesia, and the study group patients were given remifentanil and propofol intravenous target controlled anesthesia, the levels of inflammatory factors, oxidative stress and neurotransmitter levels of the two groups were compared before anesthesia induction (T0), tracheal intubation (T1) and extubation (T2) at three time points.Results:No statistical difference of the levels of hs-CRP, TNF-α, MDA, SOD, NE, ALD and PRA between the two groups at T0 moment (P>0.05). Compared with the levels of T0 moment in the same group, hs-CRP, TNF-α, MDA, NE, ALD and PRA levels in the two groups of T1 and T2 increased at different degrees, and the level of SOD decreased (P<0.05). The levels of hs-CRP and TNF-α at the time of T1 and T2 in the study group were (13.18±2.29) mg/L, (70.92±18.97) ng/L, (15.53±4.78) mg/L and (89.15±29.56) ng/L, respectively, which were significantly lower than those of the control group at the same time (allP<0.05). The MDA levels at the T1 and T2 levels of the study group were (3.69±0.42) mmol/L and (4.74±0.51) mmol/L, respectively, which were significantly lower than those of the control group at the same time (allP<0.05). The SOD level were (67.66±9.50) U/mL and (63.21±5.64) U/mL, respectively, which were significantly higher than those of the control group at the same time (allP<0.05).The NE, ALD and PRA levels at the T1 and T2 levels of the study group were (310.29±20.38) ng/mL and (314.62±19.61) ng/mL, (220.89±15.21) pg/mL and (233.62±15.85) pg /mL and (4.75±1.28) ng/mL/24 h and (4.87±1.32) ng/mL/24 h, respectively, which were significantly lower than the control group at the same time (allP<0.05).Conclusion: Remifentanil combined with propofol target controlled anesthesia can effectively reduce the inflammatory response and improve the oxidative stress status in patients undergoing cerebral surgery, and have little influence on neurotransmitter indexes, which has an important clinical value.