piperidines and Pneumoperitoneum

The purpose of this study was to evaluate the effects of low-dose dexmedetomidine on hemodynamics and anesthetic requirements during propofol and remifentanil anesthesia for laparoscopic cholecystectomy. Thirty adult patients were randomly allocated to receive dexmedetomidine infusion of 0.3 μg/kg/h (dexmedetomidine group, n = 15) or comparable volumes of saline infusion (control group, n = 15). Target controlled infusion of propofol and remifentanil was used for anesthetic induction and maintenance, and adjusted in order to maintain a bispectral index of 40-55 and hemodynamic stability. We measured hemodynamics and recorded total and mean infused dosages of propofol and remifentanil. For anesthesia induction and maintenance, mean infused doses of propofol (121 ± 27 vs. 144 ± 29 μg/kg/min, P = 0.04) and remifentanil (118 ± 27 vs. 150 ± 36 ng/kg/min, P = 0.01) were lower in the dexmedetomidine group than in the control group, respectively. The dexmedetomidine group required 16 % less propofol and 23 % less remifentanil. During anesthetic induction and maintenance, the dexmedetomidine group required fewer total doses of propofol (9.6 ± 2.3 vs. 12.4 ± 3.3 mg/kg, P = 0.01) and remifentanil (9.6 ± 3.4 vs. 12.7 ± 2.6 μg/kg, P = 0.01). The change in mean arterial pressure over time differed between the groups (P < 0.05). Significantly lower mean arterial pressure was observed in the dexmedetomidine group than in the control group at immediately and 5 min after pneumoperitoneum. The time to extubation after completion of drug administration did not differ between the groups (P = 0.25). This study demonstrated that a low-dose dexmedetomidine infusion of 0.3 μg/kg/h reduced propofol and remifentanil requirements as well as hemodynamic change by pneumoperitoneum without delayed recovery during propofol-remifentanil anesthesia for laparoscopic cholecystectomy.

Topics: Adult; Anesthesia, General; Anesthesia, Intravenous; Anesthetics; Anesthetics, Intravenous; Arterial Pressure; Blood Pressure; Carbon Dioxide; Cholecystectomy; Dexmedetomidine; Female; Heart Rate; Hemodynamics; Humans; Male; Middle Aged; Piperidines; Pneumoperitoneum; Propofol; Remifentanil; Time Factors

The effect of remifentanil on stress response to surgery is unclear. However, there are not clinical studies investigating the relationship between blood remifentanil concentrations and stress hormones. Therefore, the aim of the present study was to assess the association between blood remifentanil concentrations measured after pneumoperitoneum and cortisol (CORT) or prolactin (PRL) ratio (intraoperative/preoperative value), in patients undergoing laparoscopic cholecystectomy.. Patients did not receive any pre-anesthetic medication. Anesthesia induction was standardized. Anesthesia maintenance was performed with inhaled sevoflurane at age-adjusted 1.0 minimum alveolar concentration and intravenous remifentanil at infusion rate ranging from 0.1 to 0.4 mcg/kg/min. Blood samples were withdrawn before anesthesia induction and 5 min after achieving a pneumoperitoneum pressure of 12 mmHg. Correlation analyses were performed to evaluate the relationship between measured blood remifentanil concentrations, CORT or PRL ratio (intraoperative/preoperative value) and remifentanil dose delivered by the pump.. A significant inverse correlation was found between CORT ratio and measured blood remifentanil concentration (p=0.03) or planned remifentanil dose (p=0.04). No correlations were found between blood remifentanil concentration and PRL ratio (p=0.83).. Our data suggest that the CORT response to surgical stress is more efficiently counteracted by increased blood remifentanil concentration.

Topics: Adult; Aged; Anesthetics, Intravenous; Cholecystectomy, Laparoscopic; Female; Humans; Hydrocortisone; Male; Middle Aged; Piperidines; Pneumoperitoneum; Prolactin; Remifentanil; Stress, Physiological

The aim of this study was to investigate whether changes in perfusion index (PI) correlate with non-invasive haemodynamic parameters (HR, BP) following the onset of pneumoperitoneum under two doses (moderate-dose (MD) and high-dose (HD)) of remifentanil and to compare its reliability.. We divided 33 patients who were scheduled for laparoscopic surgery under general anesthesia into two groups according to the dose of continuously infused remifentanil: moderate dose 0.5 μg x kg(-1) x min(1) (MD group, n = 16) and high dose 1.0 μg x kg(-1) x min(-1) (HD group, n = 17). Non-invasive blood pressure (NIBP), HR, and PI were measured before the start of surgery (time 1), after the start of surgery (time 2), before the start of pneumoperitoneum (time 3), and 1 min after the stable state of pneumoperitoneum (time 4).. PI decreased from the baseline after pneumoperitoneum in MD group, on the other hand PI did not change in HD group. Between the two groups, the magnitude of the PI changes was statistically different although MBP and HR were not statistically different. PI may be a reliable and easier alternative to conventional haemodynamic parameters for detection of stress response to pneumoperitoneum during remifentanil anaesthesia in adult patients.

Topics: Anesthesia, General; Anesthetics, Intravenous; Female; Hemodynamics; Humans; Laparoscopy; Male; Middle Aged; Piperidines; Pneumoperitoneum; Remifentanil; Reproducibility of Results

Although laparoscopic surgery is minimally invasive, it produces stress responses to an extent similar to that of conventional laparotomy. Both epidural anesthesia and remifentanil intravenously (i.v.), combined with general anesthesia, provide stable hemodynamics during laparoscopic surgery. However, it has not been elucidated whether epidural anesthesia and remifentanil are associated with suppression of autonomic and neuroendocrine stress responses. This study aimed to clarify whether thoracic epidural anesthesia (TEA) or remifentanil suppresses stress responses during laparoscopic surgery.. We assigned 60 patients undergoing laparoscopic colectomy to three groups anesthetized with 40 % oxygen-air-sevoflurane plus either TEA (TEA group), continuous infusion of remifentanil 0.25 μg/kg/min [low-dose (LD) group], or 1.0 μg/kg/min [high-dose (HD) group] (n = 20 each group). Plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol, antidiuretic hormone (ADH), and catecholamines were measured immediately before anesthesia induction, and 30 and 90 min after the start of pneumoperitoneum.. All groups showed no significant changes in hemodynamics during the course of anesthesia. Compared with TEA, both high-dose and low-dose remifentanil significantly suppressed increases in ACTH, ADH, and cortisol during pneumoperitoneum. Plasma adrenaline showed no significant changes during pneumoperitoneum in any group. Compared with TEA, low-dose remifentanil produced significantly higher plasma concentrations of noradrenaline and dopamine during pneumoperitoneum.. Notwithstanding similar hemodynamic responses in all groups, only high-dose remifentanil suppressed both sympathetic responses and the hypothalamus-pituitary-adrenal axis. This result indicates that of these three anesthesia regimens, high-dose remifentanil seems most suited for laparoscopic surgery.

Topics: Adrenocorticotropic Hormone; Aged; Analgesics, Opioid; Anesthesia, Epidural; Anesthesia, General; Catecholamines; Colectomy; Epinephrine; Female; Hemodynamics; Humans; Hydrocortisone; Laparoscopy; Male; Middle Aged; Norepinephrine; Piperidines; Pneumoperitoneum; Remifentanil; Stress, Physiological; Vasopressins

We retrospectively examined the effect of remifentanil on urine output during gynecological laparoscopic surgery under general anesthesia performed from April 2006 to July 2007.. Forty six patients undergoing gynecological laparoscopic surgery under general anesthesia were divided into 2 groups. In group C (n=23), anesthesia was performed using sevoflurane and/or propofol with intermittent fentanyl. In group R (n=23), remifentanil was additionally used with the method of group C.. Patient's demography was not different between the two groups. Intraoperative conditions were compatible in both groups. In group R, total dose of fentanyl is significantly lower than group C. BP and HR measured at 20 min after pneumoperitoneum were significantly lower in group R. Intraoperative urine output was significantly greater in group R than group C.. A decrease in urine output is commonly seen particularly in laparoscopic surgery. Increased stress hormonal responses due to pneumoperitoneum have been explained as one of the causes of this phenomenon. Remifentanil has been reported to maintain urine output as well as to blunt hormonal responses in CABG surgery. Although we did not measure hormonal responses in the present study, increased urine output could be attributed to decreased catecholamine levels by remifentanil.

Topics: Adult; Anesthesia, General; Female; Gynecologic Surgical Procedures; Humans; Intraoperative Period; Laparoscopy; Piperidines; Pneumoperitoneum; Remifentanil; Retrospective Studies; Urination; Young Adult

In the anesthetic management of laparoscopic surgery, hemodynamic changes appear on the skin incision and pneumoperitoneum. Remifentanil may suppress the cardiovascular changes on the pneumoperitoneum in the laparoscopic cholecystectomy (LC).. One hundred-seven patients scheduled for LC were assigned into two groups; remifentanil (R), and epidural (E) groups. In R group, remifentanil was administered at 0.2 microg x kg(-1) x min(-1) from the induction of anesthesia. In E group, an epidural catheter was placed between T10-12 and 0.2% ropivacaine was infused continuously at 6 ml x hr(-1) via epidural catheter. Anesthesia was maintained by propofol at 5 mg x kg(-1) x hr(-1) following the induction by propofol and vecuronium in both groups. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and bispectral index (BIS) were compared at the entrance of the operating room, skin incision, pneumoperitoneum and extubation of the endotracheal tube between two groups.. At the pneumoperitoneum, statistical significance was found in HR, but there was no significant difference in blood pressure and BIS between the two groups.. Compared with epidural anesthetic management, remifentanil suppresses significantly the elevation of heart rate, but not blood pressure at the pneumoperitoneum.

Topics: Aged; Anesthesia, Epidural; Anesthesia, Intravenous; Anesthetics, Intravenous; Cholecystectomy, Laparoscopic; Female; Hemodynamics; Humans; Infusions, Intravenous; Male; Middle Aged; Piperidines; Pneumoperitoneum; Remifentanil