Effect Of Remifentanil On The Hemodynamics, Glucose, Lactate And Cortisol At Extubation Period After General Anaesthetic Patients

Objective:To observe the effects of remifentanil on SBP, DBP, HR, glucose, lactate and cortisol at extubation after general anaesthetic patients, evaluate the result of remifentanil on tracheal extubation and search for a suitable dosage for domestic people.Methods:Sixty ASA I -II patients undergoing elective operation under general anesthesia were randomly divided into 5 groups with twelve patients in each group. Group I received 0.9% sodium chloride injection 10mL iv, group II remifentanil 0.25μg·kg^-1 iv, group III remifentanil 0.5μg·kg^-1 iv, group IV remifentanil 0.75μg·kg^-1 iv, and group V esmolol 1.5mg·kg^-1 iv. All test drugs were injected intravenously more than 30s. The blood sample were taken before extubation, at the time of extubation and 2, 5, 10min after extubation for determination of plasma cortisol, lactate and glucose, recorded the changes of hemodynamics and incidence of side effects such as lethargy and respiratory depression.Results:The patients of five groups were comparable with respect to age, gender, body weight, SBP, DBP, HR, SpO₂, type of operation and duration of operation. Compared with before extubation, SBP, DBP and HR increased significantly at the time of extubation and 2min after extubation(P<0.01), recovered after 5min in group I . SBP and DBP showed no significant increase but HR increased significantly in group II (P<0.01). There were significant decrease of SBP and DBP at extubation and 2min after extubation(P<0.01), recovered after 5min, but HR was low during extubation period in group III. SBP showed significant decrease during extubation period, DBP decreased at the time of extubation and recovered after 5min, HR decreased at extubation and 2min after extubation in group IV. SBP, DBP and HR all decreased at extubation in group V(P<0.05). Compared with group I , there were no difference in SBP, DBP and HR during extubation in group II (P>0.05), there were significant decreases of SBP, DBP and HR in group III, IV and V (P<0.05). Compared with group II, SBP, DBP and HR decreased significantly at the time of extubation in group III IV and V (P<0.05), DBP showed differences in group III and SBP showed differences in group IV and V at 2min after extubation. There were significant increase in glucose at extubation and 2, 5, 10min after extubation in each group. Compared with group I and II, the increment of glucose in group III was significantly small at extubation(P<0.05). Cortisol increased significantly after extubation in group I , but increased less in other groups and showed significant difference compared with group I . Lactate increased slightly at extubation, but recovered after breath in 100% oxygen, there was no significant difference in five groups. Four patients with bucking occurred in group I , significantly higher than those of group III and IV (P<0.05), but similar to group V (three patients). Six patients with lethargy and four patients with respiratory depression occurred in group IV.Conclusion:Iv. inject different doses of remifentanil(0.5μg·kg^-1, 0.75μg·kg^-1)before extubation can attenuate the increase of hemodynamics, glucose, lactate and cortisol at tracheal extubation, the result is more efficient than esmolol and 0.5μg·kg^-1 is perfect.