[Stress response under continuous infusion of remifentanil compared to bolus doses of fentanyl assessed by levels of cytokines, C-reactive protein, and cortisol during and after abdominal hysterectomy].
OBJECTIVE
Surgery and anesthetic method have immunomodulating effects on hemodynamic response and stress. We compared the effects of 2 intraoperative analgesic regimens on patients undergoing abdominal hysterectomy.


METHODS
We conducted a randomized double-blind trial in ASA 1 and 2 patients undergoing abdominal hysterectomy under balanced anesthesia. Twenty-nine patients were randomized to 2 groups. One group received analgesia by infusion of remifentanil plus morphine and nonsteroidal anti-inflammatory drugs as rescue medications; the other received conventional analgesia with bolus doses of fentanyl according to changes in hemodynamic variables. We measured levels of proinflammatory (interleukin [IL]-6) and antiinflammatory (IL-10) cytokines, cortisol, and C-reactive protein preoperatively, at incision, and at 1, 4 and 24 hours after surgery.


RESULTS
There were no significant differences between the 2 groups in terms of the markers studied at baseline. In each group, however, there were significant changes from baseline at the various points in time. IL-6 and IL-10 levels were significantly elevated (P < .05) at 4 hours. The changes in cortisol levels were significantly different at 1 and 4 hours. Finally, there were significant increases in C-reactive protein at 24 hours.


CONCLUSIONS
Unlike other clinical trials, our study detected no differences between the 2 techniques in response to surgical stress evaluated by analyzing concentrations of pro- and anti-inflammatory cytokines, cortisol, and C-reactive protein.
Rodríguez
R
R
Servicio de Anestesiología y Reanimación, Hospital del Servicio Andaluz de Salud, Jerez de la Frontera, Cádiz.
Martínez
E
E
Santana
M
M
Rodríguez Huertas
E
E
D000368:Aged; D000768:Anesthesia, General; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis* / Q000378:metabolism; D004177:Dipyrone / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism; D007044:Hysterectomy; D007249:Inflammation / Q000097:blood / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D016753:Interleukin-10 / Q000097:blood* / Q000378:metabolism; D015850:Interleukin-6 / Q000097:blood* / Q000378:metabolism; D007431:Intraoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D007700:Kinetics; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy* / Q000517:prevention & control; D000077208:Remifentanil; D013312:Stress, Physiological / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; C508609:IL10 protein, human; C508600:IL6 protein, human; D015850:Interleukin-6; D009294:Narcotics; D010880:Piperidines; D016753:Interleukin-10; D004177:Dipyrone; D009020:Morphine; D002097:C-Reactive Protein; D000077208:Remifentanil; D005283:Fentanyl; D006854:Hydrocortisone