Effect of different doses of remifentanil on stress response during laparoscopic cholecystectomy

Authors

  • Laura Levantesi, MD
  • Flaminio Sessa, MD
  • Elisabetta Congedo, MD
  • Francesco Di Nardo, MD
  • Marco Oggiano, MD
  • Gennaro Canistro, MD
  • Rossella Sicuranza, MD
  • Luca Nicosia, MD
  • Germano De Cosmo, PhD

DOI:

https://doi.org/10.5055/jom.2019.0485

Keywords:

remifentanil, cortisol, prolactin, growth hormone, adrenocorticotropic hormone, stress, general anesthesia

Abstract

Objectives: An adequate perioperative analgesia reduces neuroendocrine stress response and postoperative complications. Opioids are the most effective parenteral drugs to control pain and stress response.

Design: This is a prospective randomized double-blinded controlled study.

Setting: Institutional tertiary level.

Patients, participants: Fifty patients underwent general anesthesia with desflurane for laparoscopic cholecystectomy.

Main outcome measures: To compare two different doses of remifentanil (0.15 mcg/kg/min or 0.3 mcg/kg/min) in reducing markers of stress. Perioperative stress was assessed through the dosage of adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), and prolactin (PRL). Three venous blood samples were collected from patients: before transferring the patient to the operating room (Time 0), at the trocar insertion (Time 1), and 1 hour after the end of the surgery (Time 2).

Results: Hemodynamic parameters showed no differences between the two groups. The authors observed an increase of GH and PRL in both groups at trocar insertion (Time 1) (p = 0.473 and 0.754, respectively). ACTH and cortisol showed a decrease at Time 1 and an increase after surgery (p = 0.586). The modification of stress parameters levels showed no significant differences between the two groups.

Conclusions: The results of our study showed that a lower dose of remifentanil is equally effective in controlling stress hormones during laparoscopic cholecystectomy.

Author Biographies

Laura Levantesi, MD

Department of Anesthesiology, and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

Flaminio Sessa, MD

Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

Elisabetta Congedo, MD

Department of Anesthesiology and Intensive Care Medicine, Perrino Hospital, Brindisi, Italy

Francesco Di Nardo, MD

Public Health Institute, Section of Hygiene, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

Marco Oggiano, MD

Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

Gennaro Canistro, MD

Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

Rossella Sicuranza, MD

Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

Luca Nicosia, MD

Department of Radiation Oncology, Sant’Andrea Hospital, “Sapienza” University of Rome, Rome, Italy

Germano De Cosmo, PhD

Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario “A. Gemelli”, IRCCS, Rome, Italy

References

Jakeways MS, Mitchell V, Hashim IA, et al.: Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg. 1994; 81: 127-131.

Marana E, Scambia G, Maussier ML, et al.: Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy. J Am Assoc Gynecol Laparosc. 2003; 10(2): 159-165.

Miller DB, O'Calligan JP: Neuroendocrine aspects of the response to stress. Metabolism. 2002; 51: S5-S10.

Adas G, Kemik A, Adas M, et al.: Metabolic and inflammatory responses after ERCP. Int J Biomed Sci. 2013; 9(4): 237-242.

Desborough JP: The stress response to trauma and surgery. Br J Anaesth. 2000; 85(1): 109-117.

Karayiannakis AJ, Makri GG, Mantzioka A, et al.: Systemic stress response after laparoscopic or open cholecystectomy: A randomized trial. Br J Surg. 1997; 84: 467-471.

Hall G, Lacoumenta S, Hart G, et al.: Site of action of fentanyl in inhibiting the pituitary-adrenal response to surgery in man. Br J Anaesth. 1990; 65: 251-253.

Draskovic B, Stanic D, Uram-Benka A, et al.: Stress indicators during general anesthesia with opioid analgesics in children. Turk J Med Sci. 2014; 44(6): 1095-1102.

Ledowski T, Bein B, Hanss R, et al.: Neuroendocrine stress response and heart rate variability: A comparison of total intravenous versus balanced anesthesia. Anesth Analg. 2005; 101(6): 1700-1705.

Sidiroupoulu I, Tsaousi GG, Pourzitaki C, et al.: Impact of anesthetic technique on the stress response elicited by laparoscopic cholecystectomy: A randomized trial. J Anesth. 2016; 30: 522-525.

Vittimberga JF, Foley PD, Meyers CW, et al.: Laparoscopic surgery and the systemic immune response. Ann Surg. 1998; 227: 326-334.

Junuzuvic D, Celic-Spuzic E, Hasanbegovic M: The correlation between type of anesthesia and hormones levels during and after transvescical prostatectomy. Acta Inform Med. 2011; 19: 216-219.

Liley DT, Sinclair NC, Lipping T, et al.: Propofol and remifentanil differentially modulate frontal electroencephalographic activity. Anesthesiology. 2010; 113(2): 292-304.

Weale NK, Rogers CA, Cooper R, et al.: Effect of remifentanil infusion rate on stress response to the pre-bypass phase of pediatric cardiac surgery. Br J Anaesth. 2004; 92: 187-194.

Shinoda T, Murakami W, Takamichi Y, et al.: Effect of remifentanil infusion rate on stress response in orthopedic surgery using a tourniquet application. BMC Anesthesiol. 2013; 13: 14. doi:10.1186/1471-2253-13-14. eCollection 2013.

Chen X, Thee C, Gruenewald M, et al.: Correlation of surgical pleth index with stress hormones during propofol-remifentanil anaesthesia. ScientificWorldJournal. 2012; 2012: 879158. doi:10.1100/2012/879158.

Hardman J, Limbird L: Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 9th ed. Columbus, OH: McGraw Hill, 1996.

Myre K, Raeder J, Rostrup M, et al.: Catecholamine release during laparoscopic fundoplication with high and low doses of remifentanil. Acta Anaesthesiol Scand. 2003; 47(3): 267-273.

Watanabe K, Kashiwagi K, Kamiyama T, et al.: High dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy. J Anaesth. 2014; 28: 334-340.

Downloads

Published

01/01/2019

How to Cite

Levantesi, MD, L., F. Sessa, MD, E. Congedo, MD, F. Di Nardo, MD, M. Oggiano, MD, G. Canistro, MD, R. Sicuranza, MD, L. Nicosia, MD, and G. De Cosmo, PhD. “Effect of Different Doses of Remifentanil on Stress Response During Laparoscopic Cholecystectomy”. Journal of Opioid Management, vol. 15, no. 1, Jan. 2019, pp. 43-49, doi:10.5055/jom.2019.0485.

Issue

Vol. 15 No. 1 (2019): January/February

Section

Articles

License

Copyright 2005-2024, Weston Medical Publishing, LLC
All Rights Reserved

Crossref
Scopus
Google Scholar
Europe PMC