Clinical Studies Of Remifentanil During Peri-operation Period

emifentanil is a new selective mu opioid receptor agonist of 5-10 times higher phar macological potency than alfentanil. Unlike other opioids, remifentanil is rapidly hydrol ysed by nonspecific plasma and tissue esterases.Its metabolism by nonspecific esterases results in rapid and uniform clearance leading to highly predictable onsetand offset of ac tion. Its elimination half-life is 3-10 minutes and plasma cleabance is about 40ml/kg/mi n, this imparts brevity of action, precise and rapidly titratable effects, non-cumulative op ioid effects and rapid recovery after cessation of administration. The onset of action of r emifentanil is similar to that of alfentanil, although its offset is considerably more rapid and independent of the duration of infusion. Its brevity of action ensures not only a rapi d resolution ofadverse effects but also a rapid effect. Therefore, the unique pharmacokin etic profile of remifentanil facilitates 'real time' management of intraoperative stress, as well as provision of optimal intraoperative analgesia without compromising recovery fo ravariety of surgical procedures. The present study is to investigate the Clinical studies of Remifentanil during peri-operation period.Part 1. Effect of preconditioning with remifentanil on the stress reaction to emergence from anaesthesia and tracheal extubation[Abstract] Objective: To investigate the effect of preconditioning with remifentanil on the stress reaction to emergence from anaesthesia and tracheal extubation. Methods: 300 ASA I ~ II patients (183 male,117 female) aged 18~65 years undergoing laparoscopic cholecystectomy scheduled for two groups in a randomized, double-blind study. All patients received a standard general anaesthesia.At the end of surgery ,a bolus dose of remifentanil lug.kg'1 (n=146)or saline placebo(n=154) was given and tracheal extubation was performed when standard criteria were achieved.Aterial pressure and heart rate were recorded non-invasively at 1-min intervals from the end of surgery.Blood sugar and Col weremeasured at the end of surgery and after the extubation. Results: Remifentanil attenuated the increase in both mean arterial pressure (p<0.05)?heart rate(p<0.05)and blood sugar(p<0.05).Mean time to extubation was 6(s=0.6)min and 5(s=0.5)min in the remifentanil and saline group.There was no difference in the incidence of coughing at extubation,time to recovery from anesthesia or time to fitness for discharge from the recovery room. Conclusion: Remifentanil attenuated the the stress reaction to emergence from anaesthesia and tracheal extubation.Part 2. Balanced anesthesia of remifentanil and desflurane during the polyp of vocal cord extirpation[Abstract] Objective: To evaluate the clinical profile of balanced anesthesia using remifentanil and desflurane during the poly of vocal cord extirpation and to compare the clinical effect and differences between remifentanil and fentanyl during the balancedanesthesia of that operation. Methods: Fifty patients scheduled for the polyp of vocal cord surgery under balanced anesthesia were randomly divided into two groups: study group anesthesia was induced with intravenous remifentanil 2 g/kg and propofol 1 -2mg/kg while maintained with remifentanil 0.2g-kg-1min-1 supplemented with 1% desflurane; control group anesthesia was induced with intravenous fentanl 2.5g/kg and propofol 1 ~ 2mg/kg, maintained with fentanl 0.03 g-kg-1min-1 and 1% desflurane. Intubation was facilitated with succinylcholine 1 ~ 1.5mg/kg. The variables recorded were the changes in blood pressure (BP), heart rate(HR) and SpO2 at different time point Recovery profile including the time of response to verbal commands, autonomous breathing, tracheal extubation, orientation recovery , discharging from PACU and the unexpected events during the operation was recorded as well. Results: Patient' s general conditions between two groups were similar. There were no significant differences in hemodynamic values and SpO2 of different time point between two groups. Study group is faster than con...