title: The effect of intraoperative use of high-dose remifentanil on postoperative insulin resistance and muscle protein catabolism: a randomized controlled study.
abstract: OBJECTIVE
  We investigated the effect of the intraoperative use of a high dose remifentanil on insulin resistance and muscle protein catabolism.
  
  
  METHODS
  Randomized controlled study.
  
  
  METHODS
  Thirty-seven patients undergoing elective gastrectomy were randomly assigned to 2 groups that received remifentanil at infusion rates of 0.1 μg·kg(-1)·min(-1) (Group L) and 0.5 μg·kg(-1)·min(-1) (Group H).
  
  
  METHODS
  Primary efficacy parameters were changes in homeostasis model assessment as an index of insulin resistance (HOMA-IR) and 3-methylhistidine/creatinine (3-MH/Cr). HOMA-IR was used to evaluate insulin resistance, and 3-MH/Cr was used to evaluate the progress of muscle protein catabolism. Intraoperative stress hormones, insulin, and blood glucose were assessed as secondary endpoints.
  
  
  RESULTS
  Eighteen patients in Group L and 19 in Group H were examined. HOMA-IR values varied within normal limits in both groups during surgery, exceeding normal limits at 12 h after surgery and being significantly elevated in Group L. There were no significant differences in the 3-MH/Cr values between the 2 groups at any time point. The stress hormones (adrenocorticotropic hormone, cortisol, and adrenaline) were significantly elevated in Group L at 60 min after the start of surgery and at the initiation of skin closure. There were no significant differences in insulin values, but blood glucose was significantly elevated in Group L at 60 min after the start of surgery and at the start of skin closure.
  
  
  CONCLUSIONS
  Use of high-dose remifentanil as intraoperative analgesia during elective gastrectomy reduced postoperative insulin resistance, although it did not reduce postoperative muscle protein catabolism.
authors.affiliation: School of Nutrition & Dietetics, Kanagawa University of Human Services, Kanagawa, Japan. hstani@aol.com
authors.forename: Hideki
authors.initials: H
authors.lastname: Taniguchi
authors.forename: Toshio
authors.initials: T
authors.lastname: Sasaki
authors.forename: Hisae
authors.initials: H
authors.lastname: Fujita
authors.forename: Osami
authors.initials: O
authors.lastname: Takano
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Hayashi
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Cho
authors.forename: Takaki
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Tsuburaya
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D009124:Muscle Proteins / Q000378:metabolism*; D010880:Piperidines / Q000627:therapeutic use*; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D009124:Muscle Proteins; D010880:Piperidines; D000077208:Remifentanil
keywords: insulin resistance; muscle protein catabolism.; remifentanil