title: Remifentanil added to sufentanil-sevoflurane anesthesia suppresses hemodynamic and metabolic stress responses to intense surgical stimuli more effectively than high-dose sufentanil-sevoflurane alone.
abstract: BACKGROUND
  Even extremely high-doses of the potent opioid, sufentanil, cannot reliably suppress stress responses to intense surgical stimuli such as sternotomy. The chemically related opioid remifentanil with its different pharmacokinetics and binding affinities for delta- and kappa-opioid receptors might be more effective in attenuating these responses.
  
  
  METHODS
  ASA I-III patients scheduled for a surgical procedure with sternotomy under balanced anesthesia (sevoflurane and sufentanil 3 μg.kg(-1) bolus, 0.017 μg.kg(-1).min(-1) infusion) were randomized into two groups. Patients in the study group were supplemented with remifentanil (2 μg.kg(-1) bolus, 2-7 μg.kg(-1).min(-1) infusion) starting ten minutes before sternotomy. Heart rate, arterial blood pressures, cardiac index, ejection fraction, systemic vascular resistance index (SVRI), total body oxygen uptake (VO2) and electric dermal response were measured and compared between the groups.
  
  
  RESULTS
  62 patients were studied (study group 32, control group 30). Systolic and mean arterial blood pressures, SVRI, VO2 and skin conductance increased during sternotomy and sternal spread in the control group but not in the study group. Systolic blood pressure increase: 7.5 ± 19 mmHg vs. -3.4 ± 8.9 (p = 0.005); VO2 increase: 31 ± 46% vs. -0.4 ± 32%; incidence of systolic blood pressure increase greater than 15 percent: 20% vs. 3% (p = 0.035) (control vs. study group).
  
  
  CONCLUSIONS
  High-dose remifentanil added to sevoflurane-sufentanil anesthesia suppresses the sympathoadrenergic response to sternotomy and sternal spread better than high-dose sufentanil alone.
  
  
  BACKGROUND
  
  
  
  BACKGROUND
  DRKS00004327, August 31, 2012.
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany.
authors: Ingo
authors: I
authors: Bergmann
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany.
authors: Torsten
authors: T
authors: Szabanowski
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany.
authors: Anselm
authors: A
authors: Bräuer
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany.
authors: Thomas A
authors: TA
authors: Crozier
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany.
authors: Martin
authors: M
authors: Bauer
authors: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical School, Robert-Koch Str. 40, 37075 Göttingen, Germany.
authors: José Maria
authors: JM
authors: Hinz
mesh_terms: D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000494:pharmacology; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000494:pharmacology*; D010880:Piperidines / Q000008:administration & dosage / Q000494:pharmacology*; D000077208:Remifentanil; D000077149:Sevoflurane; D056346:Sternotomy / Q000009:adverse effects*; D013312:Stress, Physiological / Q000187:drug effects* / Q000502:physiology; D017409:Sufentanil / Q000008:administration & dosage* / Q000494:pharmacology*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D017409:Sufentanil; D000077208:Remifentanil
keywords: Intraoperative hypertension; Oxygen uptake; Remifentanil; Sternotomy; Stress response