title: Remifentanil and glucose suppress inflammation in a rat model of surgical stress.
abstract: OBJECTIVE
  Postoperative stress produces an inflammatory response. Recent studies have shown that narcotic analgesics suppress the immune system. Nutritional management during perioperative care has also been reported to affect inflammation. We therefore examined whether remifentanil or glucose administration could ameliorate postsurgical inflammatory responses using a rat model of surgical stress.
  
  
  METHODS
  We divided male Wistar rats randomly into five groups: (1) control, (2) sevoflurane+lactated Ringer's solution, (3) sevoflurane+lactated Ringer's solution with 1% glucose, (4) sevoflurane+remifentanil+lactated Ringer's solution, and (5) sevoflurane+remifentanil+ lactated Ringer's solution with 1% glucose. In all groups, serum samples were obtained at various time points after surgery, and secreted cytokine concentrations were determined. In addition, we assessed the activation of protein kinase B (Akt) and forkhead/winged helix box class O (FOXO3), which play a role in gluconeogenesis/stress responses.
  
  
  RESULTS
  Surgical stress increased the serum concentrations of tumor necrosis factor-α and interleukin-6. Groups receiving remifentanil with anesthesia showed an attenuated inflammatory response. The inflammatory response was also reduced by administering 1% glucose. Furthermore, 1% glucose induced Akt and FOXO3 phosphorylation in the quadriceps femoris muscle 12 h after surgery.
  
  
  CONCLUSIONS
  Anesthesia based on remifentanil and perioperative administration of lactated Ringer's solution containing 1% glucose may be able to control inflammatory responses caused by surgical stress.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka-Hasamamachi, Yufu, Oita, 879-5593, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Iwasaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hagiwara
authors.forename: Rie
authors.initials: R
authors.lastname: Hasegawa
authors.forename: Kyousuke
authors.initials: K
authors.lastname: Kudo
authors.forename: Junya
authors.initials: J
authors.lastname: Kusaka
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Asai
authors.forename: Takayuki
authors.initials: T
authors.lastname: Noguchi
mesh_terms: D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000818:Animals; D001786:Blood Glucose / Q000032:analysis; D000071316:Forkhead Box Protein O3; D051858:Forkhead Transcription Factors / Q000378:metabolism; D005947:Glucose / Q000008:administration & dosage* / Q000032:analysis; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007249:Inflammation / Q000517:prevention & control*; D015850:Interleukin-6 / Q000097:blood; D007552:Isotonic Solutions / Q000737:chemistry; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D023421:Models, Animal; D010766:Phosphorylation; D010880:Piperidines / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D051057:Proto-Oncogene Proteins c-akt / Q000378:metabolism; D052097:Quadriceps Muscle / Q000378:metabolism; D051381:Rats; D017208:Rats, Wistar; D000077208:Remifentanil; D000077325:Ringer's Lactate; D000077149:Sevoflurane; D013312:Stress, Physiological / Q000187:drug effects*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D018685:Anesthetics, Inhalation; D001786:Blood Glucose; C499515:FOXO3 protein, rat; D000071316:Forkhead Box Protein O3; D051858:Forkhead Transcription Factors; D006993:Hypnotics and Sedatives; D015850:Interleukin-6; D007552:Isotonic Solutions; D008738:Methyl Ethers; D010880:Piperidines; D000077325:Ringer's Lactate; D014409:Tumor Necrosis Factor-alpha; D000077149:Sevoflurane; D051057:Proto-Oncogene Proteins c-akt; D005947:Glucose; D000077208:Remifentanil