Hemodynamics And Catecholamine Release Of Remifentanil In Burns Patients Undergoing Early Tangential Excision

Background: To observe fentanyl-based with remifentanil-based anesthesia as regard the intraoperative hemodynamic and catecholamine release in burns patients undergoing tangential excision surgery,to evaluate the stress response of remifentanil and fentanyl.Method: In a randomized, prospective study we assigned 52(ASAII-III) patients scheduled for tangential excision surgery. The patients were randomized to receive either fentanyl(F-group) or remifentanil(R-group). both groups were induced by intravenous to midazolam 0.05mg/kg, propofol 1.5mg / kg, rocuronium 0.8mg / kg. R-group remifentanil 0.8μg / kg, infusion time is longer than 60 seconds, to finish within 2min.F-group fentanyl 4μg / kg, then intubation.Two groups using propofol 4-5 mg.kg-1. h-1 maintain sedation by continuous, R-group maintain with remifentanil 0.1-0.2μg /(kg.min), to maintain with 0.2-0.25μg / kg for each additional half hour. haemodynamics, plasma levels of norepinephrine, epinephrine were measured at the following points: before induction(T1); induction(T2);1min after intubation(T3); 10 min,20min after surgery incision(T4-T5); 1min after extubation(T6). Recovery time was recorded postoperatively.Result: 1.After induction, the mean arterial was decreased in two groups and R-group showed significantly lower than F-group. The value of intraoperative maintained lower than base line, in both groups the MAP was statistically significant at T2, T3 and T5 point(P <0.05); MAP value of T2-T5 showed significantly lower than baseline T1 in R group, F group only T2 did(P <0.05)2. In the R-group,the heart rate was significant difference lower as compared to baseline levels at T3- T6. Compared to F group,R group was lower at T3- T5 point and was statistically significant difference(P <0.05).3. The two groups showed no significant difference in the glucose, In F-group, T6 significantly increased compared with T1(P <0.05). In R-group, T4 were significantly lower than TI and there was statistically significant(P <0.05).4. The levels of norepinephrine were comparable between groups. While, the epinephrine was significant lower in R-groups at T4 and T5.5. Eye-open and extubation time was shorter in the R-group than F-group. Eye-open and extubitaon time was shorter in the R-group than F-group.Conclusion: In the present study we demonstrated that in burns patients surgery remifentanil, as compared to fentanyl,was associated with a better control of intraoperative hemodynamic and epinephrine. Moreover, remifentanil provides a better recovery profile.