The Effect Of Sufentanil On The Stress Response Of Laparoscopic Hysterectomy

Objective:To explore the effect of sufentanil total intravenous anesthesia on the stress response of Laparoscopic hysterectomy and to find if there was any differences among sufentanil,fentanyl and remifentanil when refers to an equipotent relationshipMethods:Sixty ASAⅠ-Ⅱpatients undergoing Laparoscopic hysterectomy were randomly divided into 3 groups (n=20). Group sufentanil(group S) was induced with sufentanil 0.6μg/kg and maintained at a rate of 0.01μg·kg-1·min-1; group fentanyl (group F) was induced with fentanyl 3ug/kg and maintained at a rate of 0.05μg·kg-1·min-1; group remifentanil (group R) was induced with remifentanil 2μg/kg and maintained at a rate of 0.2μg·kg-1·min-1.each group was induced with midazolam 0.1mg/kg,etomidate 0.3mg/kg,attacurium 0.8mg/kg intraven-ous injection and tracheal intubation when BIS value was below 60.Systolic blood pressure (SBP), Diastolic blood pressure (DBP), Mean arterial pressure (MAP), Heart rate (HR) were recorded before induction (T0),2min after tracheal intubation (T1),10min after pnemoperitoneum (T2),being hysterotomied(T3),2min after tracheal extubation (T4).blood sample were taken at T0 to T4 for monitor of glucose and determination of plasma concentration of cotisol(Cor), norepinephrine(NE),epinephrine (E),interleukin-6(IL-6) and interleukin-10(IL-10).the Perioperative condi-tion of patients were recorded:Duration of surgery and Pneumoperi-toneum, the time for awakening and tracheal extubation,blood loss volume,propofol consumption,Postoperative pain,vomit,restless and other adverse effects were recorded.the data were analyzed.A probability of smaller than 0.05 was accepted as significant.Results:1.SBP,DBP,MAP:There was no significant differences between group S and group R at T1 to T4 (P>0.05);but significant increase of SBP,DBP,MAP at T2,T4 in group F compared with T0 (P＜0.05). SBP,DBP,MAP at T1 to T4 in group S and T2,T3 in group R were lower than group F(P<0.05). SBP,MAP at T1 to T4 showed no differences between group F and group S. 2.HR:HR at T1,T4 in group S showed little differences compared with To(P>0.05);but in group F showed significant incerese compared with To (P<0.05).There was significant incerese in group R at T4 compared with To (P＜0.01). HR at T1,T2,T3 among there groups showed no significant differences (P>0.05), but group R was slower than group F (P<0.05). group S was slower than group R and F at T4 (P<0.05).3.Glu:there were significantly increase of Glu in group S and group R at T3 compared with T0(P<0.05);Glu at T3,T4 in group F showed significant increase compared with T0(P<0.01). Glu at each time in group S and the glucose at T2,T3 in group R was lower than group F (P<0.05),but there was no significant differences between group S and group R (P>0.05).4.Endocrine Hormone:Cor at T1 and NE at T4 in group S was significantly lower than T0(P<0.05);Cor and E showed significant increase in group F at T3 compared with T0(P<0.05);Cor and NE in group R at T1 was significantly lower than To (P＜0.05). NE,E in group S at T1 and Cor in group R at T1 were lower than group F (P<0.05);Cor,NE,E in group S and group R at T2,T3,T4 were lower than group F (P<0.05),but there was no difference between group S and group R(P>0.05).5.IL-6 and IL-10:IL-10 in group S and group F at T2 were significantly higher than T0(P<0.05);both IL-6 and IL-10 in group F at T3 were significantly higher than T0(P<0.05). both IL-6 and IL-10 in group S were significantly lower than group F at T,,T3,T4 (P＜0.05). IL-6 at T1,T2 in group R and IL-10 at T3 were significantly lower than group F(P<0.05),but there was no statistical significant statistical differences between group R and group S at T1,T2 (P>0.05).6.Propofol consumption:there was no significant differences between group S and group R(P>0.05),but group S use less propofol than group F(P<0.01).7.Wakeup time and traeheal extubation time:The wakeup time in group S was longer than group R(P<0.05), but there was no differences compared with group F(P>0.05). the traeheal extubation time in three groups also showed no differences (P>0.05).8.Side effect:Group S suffers less postoperative pain than group R (P＜0.05); there was no differences of Postoperative restless,vomit,chill and tachycardia among three groups (P>0.05).Conclusions:1.Sufentanil(0.01μg·kg-1·min-1)can inhibit the stress response of operation,traeheal intubation,traeheal extubation more effectively than fentanyl,the effect of sufentanil is stronger than fentanyl refers to an equipotent relationship of 1:5,and the hemodynamics was more stable.2.Compared with sufentanil(1:20),remifentanil(0.2μg·kg-1·min-1) can meet the need of surgery, and the traeheal extubation time is shorter, but suffers more postoperative pain.