Effects Of Sevoflurane-remifentanil And Propofol-remifentanil On Blood Glucose And Insulin Sensitivity In Patients Undergoing General Anesthesia

Objective: To observe the effects of sevoflurane-remifentanil and propofol-remifentanil on blood glucose and insulin sensitivity in patients undergoing general anesthesia.Methods: 40 patients undergoing elective lumbar spine surgery under general anesthesia,ASA grade I^II,male or female,aged 18-60 years,with body mass index of 18²5kg/m2,were randomized into two groups: sevoflurane combined with remifentanil group（group SR,n=20）and propofol combined with remifentanil group（group PR,n=20）.The group SR received intravenous injection of midazolam 0.05 mg/kg,sufentanil 0.3⁰.4 ug/kg and cisatracurium besilate 0.2 mg/kg,and inhaled 6% sevoflurane through a facial mask for anesthesia induction.The group PR received intravenous injection of propofol 1.5 mg/kg instead of sevoflurane inhalation,while the remaining medications were the same as those in the group SR for anesthesia induction.During the surgery,the group SR inhaled 1.5%².5%sevoflurane combined with continuous intravenous pump injection of remifentanil 0.25⁰.5μg/kg/min for anesthesia maintenance,while the group PR received continuous intravenous pump injection of propofol 4¹2 mg/kg/h combined with remifentanil 0.25⁰.5 μg/kg/min for anesthesia maintenance.Intraoperative BIS value was maintained at 40-60.Glucose（Glu）,C peptide,insulin（Ins）and cortisol（Cor）concentrations in elbow venous blood were determined before anesthesia（T₀）,5min after tracheal intubation（T₁）,1h during operation（T₂）,2h during operation（T₃）and 15 min after tracheal extubation（T₄）in the two groups of patients.Insulin sensitivity index（ISI）and resistance index（IRI）were calculated by using the formula,and the HR,MAP,BIS value,axillary temperature and number of cases ofintraoperative blood glucose abnormalities（deviate from normal）at the five time points in the two groups of patients were recorded.Results:（1）There was no statistical difference in general information between the two groups（P>0.05）.（2）There were no statistical differences in the HR,MAP,BIS value or axillary temperature between the two groups of patients at the same time points（P>0.05）;the HR,MAP and BIS value in both groups of patients were decreased at T₁,T₂ and T₃ compared with T₀（P<0.05）,but rose at T₄ to close to those at T₀（P>0.05）.（3）There were no statistical differences in the Glu,Ins or C peptide at T₀ and T₁（P>0.05）between the two groups of patients;at T₂,T₃ and T₄,the Glu in group PR was lower than that in group SR（P <0.05）,while the Ins and C peptide were higher than those in group SR（P <0.05）;at the same time points,there were no statistical differences in the Cor,ISI and IRI between the two groups（P>0.05）.Intra-group comparison showed that the Glu and Cor were decreased at T₁ than T₀ in group SR（P <0.05）,while there were no statistical differences in the Glu,Ins,C peptide,ISI and IRI at T₂,T₃ and T₄ from those at T₀（P >0.05）.In group PR,the Glu and Cor at T₁,T₂,T₃ and T₄ were all lower than those at T₀（P <0.05）;there were no statistical differences in the Ins and C peptide at T₁ from those at T₀（P >0.05）,but at T₂,T₃ and T₄,the Ins and C peptide were increased compared with those at T₀ and T₁（P <0.05）,and there were no statistical differences in the ISI and IRI from those at T₀（P>0.05）.（4）There was no statistical difference in the incidence of intraoperative blood glucose abnormality between the two groups（P>0.05）.Conclusion: Sevoflurane-remifentanil and propofol-remifentanil for general anesthesia do not affect insulin sensitivity,but propofol combined with remifentanil for general anesthesia demonstrates a trend of promoting insulin secretion,so that blood glucose is relatively low intraoperatively and in the recovery period.