effect of target controlled infusion of remifentanil combined with sufentanil on stress reaction and postoperative pain of elderly patients in perioperative period

Abstract

Objective: To explore the effect of target controlled infusion (TCI) of remifentanil combined with sufentanil on the stress reaction and postoperative pain of elderly patients in perioperative period.Methods: Ninety-four patients receiving general anesthesia who underwent upper abdominal operation selectively were collected and randomly assigned into observation group (n=47) and control group (n=47). The patients in control group were given remifentanil 5 ng/mL for anesthesia induction and 4 ng/mL for anesthesia maintenance. Patient-controlled intravenous analgesia (PCIA) was conducted at the time of suture. The patients in observation group were given remifentanil and sufentanil 2 ng/mL for anesthesia induction and maintenance. PCIA was performed at the time of suture. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of patients in two groups were compared respectively before anesthesia (T1), before intubation (T2), 1 min after intubation (T3), 1 min after laparotomy (T4) and 1 min after extubation (T5). The violent fluctuation times of intraoperative hemodynamics were closely observed. The levels of serum cortisol and glucose before operation, during operation, 12 h and 24 h after operation, visual analogue scale (VAS) scores and doses of analgesics at different postoperative time points were also recorded.Results: Both SBP and DBP at different time points as well as HR at T3 and T4 were significantly lower in observation group than in control group, and the difference was shown statistically significance (P<0.05 or P<0.01). The violent fluctuation times of intraoperative hemodynamics were (2.7±1.2) in observation group and (3.9±1.7) in control group, and the difference was shown statistically significance (t=3.954, P<0.001). The levels of serum cortisol and glucose, VAS scores and doses of analgesics were all significantly lower in observation group than in control group at different postoperative time points, and there was statistical significance (P<0.05 or P<0.01).Conclusion: For elderly patients in perioperative period, TCI of remifentanil combined with sufentanil can effectively attenuate the increase of blood pressure and HR, maintain the fluctuation times of hemodynamics and depth of anesthesia, and decrease the stress reaction and postoperative doses of analgesics.