High- And Low-Dose Fentanyl Anaesthesia: Hormonal and Metabolic Responses During Cholecystectomy

Abstract

We have compared two groups of patients given low- or high-dose fentanyl anaesthesia. Arterial blood samples were collected for measurement of glucose, free fatty acids (FFA), glycerol, beta-hydroxy-butyrate, insulin, c-peptide, glucagon, human growth hormone (HGH), cortisol and adrenaline concentrations. After induction of anaesthesia, blood concentrations of most of these substances decreased. After the start of surgery the concentrations of cortisol, glucose, HGH, FFA and beta-hydroxy-butyrate increased significantly in the group anaesthetized with the lower dose of fentanyl. In the group that received high-dose fentanyl anaesthesia the plasma concentrations of almost all the hormones and substances measured remained relatively low. The differences between the two groups during surgery were significant for adrenaline (P less than 0.001) and cortisol (P less than 0.001). High-dose fentanyl appears to block the trauma-induced stress response seen in patients anaesthetized with low dose fentanyl.

Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial

“…Opioids are known to reduce the hypothalamic-adrenal response to surgery, 26 and to depress sympathetic activity in a dose-dependent manner. 27,28 Although norepinephrine secretion has been shown to be reduced by opioid administration, 29 in our study the increase in norepinephrine was not attenuated by remifentanil infusion, as previously described. 30 This supports the hypothesis that norepinephrine, released mainly from sympathetic nerve endings, is not significantly affected by systemic opioid administration.…”

Increased spillover of norepinephrine to the portal vein during CO2‐pneumoperitoneum in pigs

“…Ketamine is known to stimulate the sympathetic nervous system (32) and could interfere with the catecholamine analyses. Therefore we used only a small dose as an induction agent and continued the anesthesia with pentobarbital and fentanyl, since opioids are known to depress the hypothalamic-adrenal response to surgery (33) and to depress sympathetic activation in a dose-dependent manner (34,35). Ketamine did not influence the sympathetic activity in the current study, as supported by no demonstration of general sympathetic activation and similar increases in norepinephrine as a response to pneumoperitoneum both before and after surgery, i.e.…”

Effects of laparotomy vs pneumoperitoneum on the hepatic catabolic stress response in ambulatory and stationary settings in pigs

“…Many studies have been done on the metabolic consequences of laparoscopic versus open cholcystectomy [2,10,11,18,20,23]. However, the results are controversial due to the complex nature of the mechanisms underlying the stress response.…”