title: Comparison of target-controlled infusion of sufentanil and remifentanil in blunting hemodynamic response to tracheal intubation.
abstract: BACKGROUND
  Maintaining blood pressure (BP) and heart rate (HR) after laryngoscopy and tracheal intubation has always been a concern in injured patients. Opioids can attenuate or stop an increase in these two parameters if administered with proper doses or targets in target-controlled infusion (TCI). Remifentanil and sufentanil are widely used for this purpose because their cardiac side effects are low and, especially in traumatic patients, they are tolerated well. A comparison of the benefits and limitations of these two opioids in TCI is much needed. A literature review in electronic data bases revealed few results.
  
  
  METHODS
  40 normotensive patients were enrolled to this randomized clinical trial study. After BIS guided anesthesia with a target-controlled propofol infusion and muscle relaxation with cisatracurium, remifentanil and sufentanil were infused using TCI with 2 and 0.2 ng.ml-1 targets respectively. BP and HR were recorded for five data points and compared with Fischer's exact test.
  
  
  RESULTS
  Systolic, mean and diastolic arterial pressure and HR in different points of the study remained below baseline values but were out of control in some cases, however the out-of-control values showed significant difference between the two groups only for heart rate changes. The relative risk for producing out-of-control changes with remifentanil compared to sufentanil is significantly more than 1 for HR decrease.
  
  
  CONCLUSIONS
  Sufentanil produced more common pre-intubation hypotension than remifentanil in propofol anesthetized patients but this hypotension disappeared sooner than remifentanil after tracheal intubation. Both opioids prevent an increase in BP and HR after tracheal intubation but the side effects (hypotension and bradycardia) may be a cause for concern (IRCT138710011361N3).
authors: Department of Anesthesiology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
authors: Naser
authors: N
authors: Yeganeh
authors: Bahman
authors: B
authors: Roshani
authors: Hossein
authors: H
authors: Latifi
authors: Afshin
authors: A
authors: Almasi
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D007431:Intraoperative Complications / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D000077208:Remifentanil; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects; D014947:Wounds and Injuries / Q000601:surgery
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D017409:Sufentanil; D000077208:Remifentanil