Effects Of Sulfentanyl And Remifentanil By Target-controlled Infusion On Stress Reaction And Hemodynamics During Induction

Objective To assess the effects of target controlled infusion(TCI) of sulfentanyl and remifentanil on stress reaction and hemodynamics during induction of general anesthesia.Methods Eighty patients undergoing elective operation under general anesthesia were randomly divided into remifentanil group(R,n=20),sulfentanyl 0.4μg/L group(S₁,n=20), sulfentanyl 0.5μg/L group(S₂,n=20),and sulfentanyl 0.6μg/L group(n=20).using step-by-step target-controlled infusion(TCI),bispectral index(BIS) was controlled under 65 by giving propofol.Systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR) and BIS were monitored and recorded after entering into operation room(T₀),before tracheal intubation(T₁),at the time of tracheal intubation(T₂),1 min after tracheal intubation(T₃),3min after tracheal intubation(T₄),5min after tracheal intubation(T₅) and 10min after tracheal intubation (T₆),concentration of cortisol and interleukin-6(IL-6) of venous blood were measured at T₀,T₄, T₅ and T₆.Results 1.HR:There were no significant differences in group comparison(P＞0.05);There were significant differences in times comparison(P＜0.05),decreased significantly after anesthesia induction and stepped up after tracheal intubation,difference between maximum values and baseline values(T₀) were not statistically significant(P＞0.05),Values of HR reverted to the level of T₁ at T₅;There were no significant differences in comparison of interaction (P＞0.05).2.DBP:There were no significant differences in group comparison(P＞0.05);There were significant differences in times comparison(P＜0.05),decreased significantly after anesthesia induction and stepped up after tracheal intubation,difference between maximum values and baseline values(T₀) were not statistically significant(P＞0.05),Values of HR reverted to the level of T₁ at T₄;There were no significant differences in comparison of interaction(P＞0.05).3.SBP: There were no significant differences in group comparison(P＞0.05);There were significant differences in times comparison(P＜0.05);There were significant differences in comparison of interaction(P＜0.05),change tendency of SBP is different under the different induction method along with the different time,SBP decreased after anesthesia induction in group R,increased quickly at the time of tracheal intubation,the differences were statistically significant (P＜0.05),5min after tracheal intubation,the values reverted to the level of T₁;In group S₁,SBP decreased after anesthesia induction,increased after tracheal intubation,the differences were statistically significant(P＜0.05),but the time to revert to the level of T₁ is 3min;In group S₂ and group S₃,differences of SBP were not statistically significant(P＞0.05).In each group,differences between maximum values and baseline values of SBP were not statistically significant(P＞0.05).4.Cortisol:There were no significant differences in group comparison(P＞0.05);There were significant differences in times comparison(P＜0.05);There were significant differences in comparison of interaction(P＞0.05), change tendency of cortisol is different under the different induction method along with the different time,cortisol:In group R and group S₁,the values increased before its decrease,in group S₂ and group S₃ the values decreased after anesthesia induction and didn't increased after tracheal intubation,the values at T₄ in group S₂ and group S₃ had significant changes compared with those in group R(P＜0.05),differences of values at T₄among group S₁,group S₂ and group S3 were statistically significant(P＞0.05).Differences of cortisol within group R were not statistically significant(P＞0.05).In group S₁,cortisol decreased significantly 5min after tracheal intubation,10min after tracheal intubation compared with 3min after tracheal intubation(P＜0.05); In group S₂,cortisol decreased after tracheal intubation compared with those before anesthesia induction,In group S₃,differences of the values 10min after tracheal intubation and those before anesthesia induction had statistically significan(P＜0.05).5.IL-6:There were no significant differences in group comparison(P＞0.05);There were no significant differences in times comparison(P＞0.05);There were no significant differences in comparison of interaction(P＞0.05).Conclusion Remifentanil at the Ce of 4μg/L,sulfentanyl at the Ce of 0.4μg/L,sulfentanyl at the Ce of 0.5μg/L and sulfentanyl at the Ce of 0.6μg/L can suppress stress reaction caused by tracheal intubation effectively,and sulfentanyl at the Ce of 0.6μg/L can suppress cardiovascular effects completely,thus the hemodynamics during anesthesia induction and tracheal intubation was more stable,secrection of stress hormone was suppressed more effectively than remifentanil.