Comparative Study Of Sufentanil And Fentanyl On Patients Undergoing Neurosurgical Surgery

ObjectiveTo compare the effects of sufentanil and fentanyl on hemodynamics,recovery profiles from general anesthesia and the stress reaction in patients undergoing intracranial tumor resection.MethodsA total of fifty ASA physical statusâ… orâ…¡patients scheduled for intracranial tumor resection were randomized to S(sufentanil) or F(fentanyl) group(25 for each). Sufentanil was performed on the patients in S group by combination of intravenous propofol and sevoflurane anesthesia while conducted on the patients in F group using fentanyl plus propofol continuous intravenous infusion followed by sevoflurane anaesthesia.Induction of anesthesia was begun with midazolam 0.04mg/kg,group S sufentanil 0.4μg/kg,group F fentanyl 4μg/kg,propofol 2mg/kg.Vecuronium 0.1 mg/kg was given on Loss of Consciousness(LOS).Tracheal intubation was performed after three minutes of induction,with mechanical ventilation,according to maintaining end-tidal carbon dioxide partial pressure(P_ET-CO₂) at 30～35mmHg regulating appropriately respiratory parameters.After intubation,sevoflurane was inhaled at the concentration of 1～2MAC,the flux of oxygen was 2L/min,followed by continuous intravenous pumping of propofol(3～4mg/kg/h) and sufentanil(0.2μg//kg/h)(group S) or fentanyl(2μg//kg/h)(group F).Vecuronium 2mg was injected at intervals of 45～60 min. For sufentanil was stopped about 30min before the end of operation.Sevoflurane was stopped after dural closure and propofol was stopped when the operation was finished. The patient's blood pressure,heart rate were continuously monitored and recorded at different time points including baseline values(T₀),post-anesthesia induction(T₁),1min after tracheal intubation(T₂),head holder application(T₃),skin and dural incisions(T₄,T₅),dural closure(T₆),spontaneous breath recovery(T₇) and after tracheal extubation(T₈).At time points including T₀,30 minutes after skin incision,1 minute after tracheal extubation(T₈),radial arterial blood sampling were underwent to detect the concentration of blood glucose(BG) and epinephrine(EPI).Time to recovery of spontaneous breath and extubation from the end of operation,postoperative pain intensity at after extubation and 2h after operation and adverse effects were recorded. Patient's follow-up visit was done in 48 hours after operation.The pain intensity,the use of supplemental analgesics and the incidence of adverse reactions were recorded.ResultsIn group F,the Heart Rates(HR) during 1min after endotracheal intubation,dural incision and closure,spontaneous breath recovery and after tracheal extubation were higher than baseline value(P＜0.05),while they were higher than baseline value during dural incision,spontaneous breath recovery and after tracheal extubation in group S(P＜0.05).Group F and S on MAP after anesthesia induction,dural incision and closure were lower than baseline values(P＜0.05).Group F on MAP at skin incision and after tracheal extubation were higher than baseline value(P＜0.05),but during skin incision and after tracheal extubation,group S was not different from baseline value(P＞0.05).Group F on MAP,HR in every intracranial episodes were higher than group S.The extubation time and the consciousness time were shorter in group S than in group F(P＜0.05),The incidence of postoperative shivering and restlessness in group S was lower than group F.The incidence of nausea and vomiting in group S was not different from that in group F(P＞0.05).VAS scores at after extubation,2h after operation,group S were lower than group F(P＜0.05).There were no differences between group F and group S about VAS scores at 48h after operations.The changes of the concentration of blood glucose(BG) and epinephrine(EPI) at each time points were similar in two groups.ConclusionsSufentanil combining with propofol and sevoflurane is superior to fentanyl in general anesthesia in intracranial surgery.Compared to fentanyl,the anesthesia induction and maintenance are more stable,and the quality of consciousness is better by the use of sufentanil.The incidence of nausea and vomiting are similar for both groups.The inhibition of fentanyl and sufentanil on the concentration of blood glucose(BG) and epinephrine(EPI) at each time points are similar.