Remifentanil-based anaesthesia increases the incidence of postoperative surgical site infection

Inagi, T.; Suzuki, Manzo; Osumi, Makoto; Bito, Hiroyasu

doi:10.1016/j.jhin.2014.10.001

Cited by 18 publications

(11 citation statements)

References 29 publications

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“…4,5 Furthermore, it has been shown that overtreatment with opioid analgesics leads to opioid-induced hyperalgesia, 6,7 higher opioid tolerance, 8 and immunosuppression. [9][10][11] Despite an understanding of nociception and its related morbidity, the development of an accurate monitoring device for detection of nociception remains challenging. In the past two decades, new parameters have been studied that have mostly evaluated the level of activation of the sympathetic ANS 12 ; skin conductance (SC), electroencephalography, electromyography, photoplethysmographic pulse wave amplitude (PPGA), and heart rate variability (HRV) have all been evaluated.…”

Section: Résumémentioning

confidence: 99%

Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli

Renaud‐Roy

Stöckle

Maximos

et al. 2019

Can J Anesth/J Can Anesth

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Background The Pain Monitoring Device (PMD) monitor (Medasense Biometrics Ltd., Ramat Gan, Israel) uses the Nociception Level (NOL) index, a multiple parameterderived index that has recently shown a good sensitivity and specificity to detect noxious stimuli. The aim of this study was to assess the latest version of the device (PMD200 TM) on variations of the NOL response after standardized tetanic stimuli to study the correlation between remifentanil doses and NOL. Methods Data from 26 patients undergoing midline laparotomy and receiving a desflurane-remifentanil-based anesthetic coupled with low thoracic epidural analgesia were analyzed. A standardized tetanic stimulus was applied to the forearm of the patients at different remifentanil infusion rates. The primary aim was to evaluate the correlation between post-tetanic stimulation NOL values from the PMD200 and remifentanil doses. The NOL index variations after experimental and clinical stimuli were also compared with heart rate (HR), mean arterial pressure (MAP), and Bispectral Index TM (BIS). Results A correlation between post-tetanic stimulation NOL values and remifentanil doses was found (r =-0.56; 95% confidence interval [CI],-0.70 to-0.44; P\0.001). The NOL discriminated noxious from non-noxious states with the maximal Youden's index value of the NOL receiver operating characteristic (ROC) curve showing a specificity of 88% (95% CI, 69.0 to 100) and sensitivity of 79.1% (95% CI, 56.2 to 95.5). The area under the NOL ROC curve (AUC, 0.9; 95% CI, 0.84 to 0.95) was significantly different from the other variables (P \ 0.001 vs HR; P \ 0.001 vs MAP; P \ 0.001 vs BIS). Conclusions The NOL value after noxious stimulus decreased with incremental remifentanil doses, showing a significant inverse correlation between the NOL index and opioid doses. The sensitivity and specificity of NOL to discriminate between noxious and non-noxious stimuli suggests its interesting potential as a monitor of nociception intensity during anesthesia.

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Section: Résumémentioning

confidence: 99%

Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli

Renaud‐Roy

Stöckle

Maximos

et al. 2019

Can J Anesth/J Can Anesth

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“…Opioid administered for the management of intra- and postoperative pain showed immunosuppressive effects [ 11 ]. In addition, remifentanil-based general anesthesia was reported to increase the postoperative SSI rate [ 12 ]. On the contrary, it was revealed that propofol had anti-inflammatory and anti-oxidative effect at clinical plasma concentrations [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical site infection after colorectal surgery according to the main anesthetic agent: a retrospective comparison between volatile anesthetics and propofol

Koo

Sim

Shin

et al. 2016

Korean J Anesthesiol

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BackgroundAnesthetic agents used for general anesthesia are emerging possible influential factors for surgical site infection (SSI). In this retrospective study, we evaluated the incidence of SSI after colorectal surgery according to the main anesthetic agents: volatile anesthetics vs. propofol.MethodsA total 1,934 adult patients, who underwent elective colorectal surgery under general anesthesia between January 2011 and December 2013, were surveyed to evaluate the incidence of SSI: 1,519 using volatile anesthetics and 415 using propofol for main anesthetic agents. Patient, surgery, and anesthesia-related factors were investigated from all patients. Propensity-score matching was performed to reduce the risk of confounding and produced 390 patients in each group.ResultsWithin the propensity-score matched groups, the incidence of SSI was higher in the volatile group compared with the propofol group (10 [2.6%] vs. 2 [0.5%], OR = 5.0 [95% CI = 1.1-2.8]). C-reactive protein was higher in the volatile group than in the propofol group (8.4 ± 5.6 vs. 7.1 ± 5.3 mg/dl, P = 0.001), and postoperative white blood cells count was higher in the volatile group than in the propofol group (9.2 ± 3.2 × 103/µl vs. 8.6 ± 3.4 × 103/µl, P = 0.041).ConclusionsThe results of this study suggest that intravenous anesthesia may have beneficial effects for reducing SSI in colorectal surgery compared to volatile anesthesia.

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“…In addition, anesthetic management may influence defense mechanisms to surgical infections as well. There is growing evidence that high doses of opioids, like remifentanil, administered during surgery might induce immunosuppression through the activation of opioid receptors expressed on leucocytes, and also increase susceptibility to infection resulting from opioid withdrawal [ 32 , 33 ]. On the contrary, some interventions such as regional nerve blocks have shown benefits in reducing the primed inflammatory response [ 34 ].…”

Section: Primed Inflammation and Immune Suppressionmentioning

confidence: 99%

Pathogenesis of infection in surgical patients

Cui

Fang²

2015

Current Opinion in Critical Care

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Purpose of reviewDespite the application of prophylactic antimicrobial therapy and advanced technologies, infection remains one of the most common causes of morbidity and mortality in surgical patients. Understanding the pathogenesis of surgical infection would offer new insights into the development of biomarkers to predict and stratify infection in patients, and to explore specific strategies to minimize this serious postoperative complication.Recent findingsThe acute nonspecific inflammatory response triggered by endogenous danger signals evoked by surgical insult is beneficial, while paradoxically associated with reduced resistance to infection. There is growing evidence indicating that primed inflammation by surgical insult exaggerates the dysregulation of the immune-inflammatory response to the invasion of pathogens postoperatively. Innate immune receptors, such as Toll-like receptors (TLRs), contribute to detecting both pathogen-associated molecular patterns and endogenous damage-associated molecular patterns, and to further amplifying inflammatory responses to infection. Current evidence shows the fascinating role of non-TLRs in the process of infection. Non-TLRs, such as membrane-associated triggering receptor expressed on myeloid cells family, cytosolic nucleotide-binding oligomerization domain-like receptors and nuclear receptor nuclear family 4 subgroup A receptors, are also crucial in triggering the immune responses and mounting an effective defense against surgical insults and the second hit of infection.SummaryUnderstanding the pivotal role of non-TLRs in sensing exogenous and endogenous molecules, and the influence of primed systemic inflammation and depressed immune status on the defense against pathogen after surgical insult, would be helpful to fully explore the relevant sophisticated phenomena of surgical infection, and to elucidate the occurrence of heterogeneous constellations of clinical signs and symptoms among this special population.

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Remifentanil-based anaesthesia increases the incidence of postoperative surgical site infection

Cited by 18 publications

References 29 publications

Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli

Correlation between incremental remifentanil doses and the Nociception Level (NOL) index response after intraoperative noxious stimuli

Surgical site infection after colorectal surgery according to the main anesthetic agent: a retrospective comparison between volatile anesthetics and propofol

Pathogenesis of infection in surgical patients

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