The Effects Of Sulfentanyl And Fentanil On Stress Reaction In Pediatric Undergoing Surgical Repair Of Congenital Cardiac Defects.

Objective: The object of my experiment is to observe the effects of sulfentanyl on hemodynamics and stress reaction in Pediatric Undergoing Surgical Repair of Congenital Cardiac Defects.Methods: Twenty-four pediatric underwent elective surgery repair of congenital cardiac defects were divided into two groups randomly. The patients were anesthetized with sufentanil (group S) or fentanil (group F) combined midazolam-propofol-vecuronium.In group S patients received 0.7μg/kg sufentanil at the beginning of induction, 0.7μg／kg sufentanil before cutting the skin, 1.5μg／kg sufentanil before stemotomy, 1.5μg/kg sufentanil at the beginning of CPB; in group F patients received 5μg/kg fentanil at the beginning of induction, 5μg/kg fentanil before cutting the skin, 10μg/kg fentanil before sternotomy, 10μg/kg fentanil at the beginning of CPB. The patients only received 0.1mg/kg midazolam, 0.15mg/kg vecuronium, 0.7μg/kg sufentanil or 5μg/kg fentanil after the induction,and the other narcotic and vasoactive agent can not be used until spliting the sternum, except for sufentanil and fentanil. The patients only received 0.05mg/kg midazolam, 0.08mg/kg vecuronium, 0.7μg/kg sufentanil or 5μg/kg fentanil as cutting the skin. The changes of MAP, HR were observed during anesthesia when getting into the operating room(t₁),induction of anesthesia (t₂),1 minute after tracheal intubation (t₃),5 minutes after tracheal intubation (t₄), 10 minutes after tracheal intubation(t₅),1 minute after cutting the skin (t₆), 1 minute after spliting the sternum (t₇). Patients received an intravenous bolus of propofol 6～9 mg·kg^-1·h^-1 after spliting the sternum until the end of operation. Blood sample was taken from radial artery when getting into the operating room (T₁), after the tracheal intubation (T₂), after spliting the sternum(T3), before rewarming (T₄), 10 minutes after the stop of CPB (T₅) 24 hours after operation(T₆) for determination of ACTH,cortisol,IL-6,glucagon,blood glucose,lactic acid.Results 1. there was no signifiant difference in age,weight,the time during of CPB and acortic cross-clamping time among the two groups.2. The MAP in group S was significantly lower than those in group F at t₄(P＜0.05). The HR in group S was significantly lower than those in group F at t₃ and t₄(P＜0.05). The MAP and HR in group F was significantly increased at t₃ and t₇ (P＜0.05). The MAP in the two groups was significantly lower than the base line value at t₂ (P＜0.05).3. There was no significant difference of ACTH,cortisol,IL-6,glucagon,blood glucose,lactic acid among the two groups before operation. ACTH increased significantly at T₂～T₅ as compared with the baseline value at T₁(P＜0.05)and decreased at T₆, and the ACTH at T₆ was also higher than the baseline value(P＜0.05). ACTH was significantly lower at T₃,T₅,T₆ in group S than in group F (P＜0.05). Cortisol increased significantly at T₃,T₅,T₆ as compared with the baseline value at T₁. Cortisol was significantly lower at T₅,T₆in group S than in group F (P＜0.05). The level of IL-6 increased significantly at T₄ and T₅ as compared with the baseline value at T₁ and decreased at T₆. IL-6 was significantly lower at T₅,T₆ in group S than in group F (P＜0.05). The level of glucagon increased significantly at T₃～T₆ as compared with the baseline value at T₁ (P＜0.05). Glucagon was significantly lower at T₃～T₅ in group S than in group F(P＜0.05). The level of lactic increased significantly at T₄～T₆ as compared with the baseline value at T₁ (P＜0.05). Lactic was significantly lower at T₄,T₆in group S than in group F (P＜0.05). The level of blood glucose increased significantly at T₃～T₅ as compared with the baseline value at T₁ (P＜0.05)and decreased at T₆. There was no significant difference in blood glucose during the operation compared group S and group F.conclusion: (1) Both sufentanil and fentanil can be safely used in pediatric heart surgery. (2)We can get more stable hemodynamics, and lower lever of ACTH,cortisol,IL-6,glucagon,lactic in the pediatric undergoing surgical repair of congenital cardiac defects, when fentanil is replaced by equivalent dose of sufentanil.