Remifentanil inhibits the traumatic stress response in emergent trauma surgery

Ouyang, Ru; Ren, Haijing; Liu, Wei; Yuan, Xia; Lei, Enjun

doi:10.1002/jcla.22971

“…At present, the LC technique in China is relatively mature, and its damage to abdominal muscles, fascia, nerves and blood vessels is small, and patients can have no obvious external trauma after surgery, leaving only one to four small incisions, which facilitates their postoperative recovery ( 13 , 14 ). However, the somatic trauma, physiological stress, metabolic changes, and the resulting painful stimuli and anxiety caused by surgery can affect several systems of patients, including neurological, endocrine, and circulatory ( 15 , 16 ). This interferes with the outcome of surgical treatment for LC patients and delays their postoperative physical and psychological recovery.…”

Section: Discussionmentioning

confidence: 99%

Study on the Application Effect of Fast Track Surgery Care Combined With Continuous Care After Discharge in Patients With Laparoscopic Cholecystectomy

Yu

¹

,

Lin

²

,

Chen

³

2022

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PurposeTo explore the application effect of fast track surgery (FTS) care combined with continuous care after discharge in patients with laparoscopic cholecystectomy (LC).MethodsTwo hundred patients treated with LC in our hospital from May 2020 to September 2021 were selected and divided into the routine group receiving routine care (n = 100) and the combined group receiving FTS care combined with continuous care after discharge (n = 100) according to their care methods. We observed the care effect, surgical stress levels [epinephrine, cortisol, Hamilton anxiety scale (HAMA)], postoperative recovery (time to first exhaust, time to first meal, time to first getting out of bed, time to hospitalization), complications, SF-36 scores after discharge, and care satisfaction in both groups.ResultsThe total efficiency of care in the combined group was better than that in the routine group (P < 0.05). At 1 d after surgery, the levels of epinephrine and cortisol in both groups were significantly higher than those at 1 h before surgery, and the HAMA scores were significantly lower than those at 1 h before surgery, and the combined group was lower than the routine group (P < 0.05). The time to first exhaustion, time to first meal, time to first getting out of bed, and time to hospitalization were shorter in the combined group than in the routine group (P < 0.05). The overall complication rate in the combined group was lower than that in the routine group (P < 0.05). The each item of SF-36 scores after discharge were higher in the combined group than in the routine group (P < 0.05). The total satisfaction with care was higher in the combined group than in the routine group (P < 0.05).ConclusionThe implementation of FTS care combined with continuous care after discharge in LC patients is ideal, which can significantly reduce the level of surgical stress, accelerate the recovery process, and reduce the occurrence of complications, and improve the postoperative quality of life of patients significantly, and with high satisfaction, which is worthy of application.

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“…Induction and maintenance anesthetics were selected with the lowest probability of myocardial inhibition to prevent hemodynamic instability. Remifentanil significantly suppresses the secretion of epinephrine and norepinephrin, [ 7 ] so it was used for intraoperative analgesia in our patient. Moreover, it is crucial to measure fluid status and avoid volume overload.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of epilepsy surgery in a patient previously diagnosed with Takotsubo cardiomyopathy: A case report

Xu

¹

,

Li

²

,

He

³

et al. 2022

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Rationale: Takotsubo cardiomyopathy (TC), also known as stress cardiomyopathy, apical ballooning syndrome, octopus pot cardiomyopathy and broken heart syndrome, is characterized by wall motion abnormalities of the left ventricle. Patient concerns: Here, we reported a 73-year-old woman diagnosed with TC induced by epilepsy before 3 months presented to the authors’ hospital with generalized tonic-clonic seizure. She was scheduled for intracranial tumor resection to cure the epilepsy. Diagnosis: She was diagnosed with epilepsy and TC. Interventions: Anesthesia management plays an important role in patients with a past history of TC. Outcomes: At the 1-week follow-up, she had fully recovered without obvious abnormalities. Lessons subsections: We emphasize the importance of individualized anesthesia management in patients with a past history of TC.

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“…Remifentanil may have decreased the cortisol level in serum and follicular fluid. Because there are studies showing that remifentanil reduces the cortisol level in addition to propofol [ 32 , 33 ], in laparoscopic colectomy, continuous remifentanil infusion suppressed the responses of the hypothalamic–pituitary–adrenal axis [ 34 ]. In this study, the postoperative cortisol level in group P was lower than the preoperative level and follicle cortisol level was lower in group P compared to group S. In group P, increased ACTH and decreased cortisol without increasing CRH is a contradiction.…”

Section: Discussionmentioning

confidence: 99%

Effects of Propofol versus Sevoflurane on Postoperative Pain and Neuroendocrine Stress Response in Oocyte Pickup Patients

Orak

¹

,

Tolun

²

,

Bakacak

³

et al. 2021

Pain Research and Management

5

0

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Background. Pain aggravates the autonomic response to stress and raises neuroendocrine stress hormone levels. We compared the effects of propofol and sevoflurane on postoperative pain and neuroendocrine stress hormones. A prospective, randomized, and controlled trial was conducted with 60 patients. Methods. We randomly allocated patients to groups P (remifentanil/propofol, n = 30) and S (remifentanil/sevoflurane, n = 30). Preoperative blood samples were taken to measure serum adrenocorticotropic hormone (ACTH), corticotropin-releasing hormone (CRH), glucagon, cortisol, aldosterone, and prostaglandin E2 (PGE2) levels. Intraoperatively and postoperatively, clinical parameters were monitored at different time points. The hormone levels were again measured in the follicular fluid and blood postoperatively. Result. Demographic data were similar. The preoperative serum aldosterone levels were significantly higher in group P ( p = 0.001 ). Preoperative and postoperative serum ACTH, glucagon, cortisol, and PGE2 levels were significantly different in group P ( p = 0.009 , p = 0.004 , p = 0.029 , and p = 0.002 ); serum ACTH, glucagon, and PGE2 levels increased while serum cortisol levels decreased postoperatively. In group S, serum CRH and aldosterone levels, both increased in the postoperative period compared to the preoperative ( p = 0.001 , p = 0.006 ). Postoperatively, glucagon and PGE2 levels were both higher in group P than group S ( p = 0.019 , p = 0.015 ). In postoperative follicular fluid, glucagon and PGE2 levels were higher in group P, while cortisol levels were higher in group S ( p = 0.001 , p = 0.007 , and p = 0.001 ). Conclusion. The effects of anesthetic agents were different. In group P, in the preoperative and postoperative evaluation, ACTH, glucagon, and PGE2 increased postoperatively, while cortisol decreased. In group S, aldosterone and CRH increased postoperatively. Glucagon and PG E2 were higher in group P than S, postoperatively.

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Remifentanil inhibits the traumatic stress response in emergent trauma surgery

Cited by 12 publications

References 27 publications

Study on the Application Effect of Fast Track Surgery Care Combined With Continuous Care After Discharge in Patients With Laparoscopic Cholecystectomy

Study on the Application Effect of Fast Track Surgery Care Combined With Continuous Care After Discharge in Patients With Laparoscopic Cholecystectomy

Anesthetic management of epilepsy surgery in a patient previously diagnosed with Takotsubo cardiomyopathy: A case report

Effects of Propofol versus Sevoflurane on Postoperative Pain and Neuroendocrine Stress Response in Oocyte Pickup Patients

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