Effect Of Sufentanil On The Hemodynamics And Cortisol In The Recovery Phase Of Remifentanil-based Anaesthesia

Objective:To investigate the effect of fentanil and remifentanil on inhibiting the trachea extubating stress responces and adverse reaction, and to search a better medication compatibility during this phaseMethods:The study subjects are 60 patients undergoing gynecological surgery, ASA physical statusⅠ～Ⅱ. The femail patients were randomized into 3 groups,20 patients in each group. In operation before the end of 30min, Group R received 0.9% sodium chloride injection 5mL iv, group F receive fentanil 1.5μg/kg iv and group S received sufentanil 0.15μg/kg iv. Drugs in each group were diluted with 0.9% sodium chloride to 5ml. Then recorded systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and SpO2 changes before injection (T1), tracheal extubation (T2),5min (T3), 10min (T4) after extubation. After taking T1, T2, T4 point venous blood samples, the samples were collected for measurement of serum cortisol concentrations. Record the patient breathing recovery time, recovery time consciousness, drowsiness, respiratory depression and other side effects. Assessment of agitation during extubation sedation score. Visual analogue score (VAS) in the standard assessment of wound pain after extubation in 5 minutes,30 minutes after extubation,1 h after extubation.Results:1. Compared with the former administration, group C patients at extubation SBP and HR significantly increased, the difference was statistically significant (P＜0.01), SBP and HR changes in 5 minutes after extubation is still statistically significant (P <0.05),10 minutes, still higher than the level before administration, but no statistical significance (P<0.05). Compared with the administration prior to extubation, patients of group F with SBP and HR during tracheal extubation and 5 minutes after extubation was significantly higher, the difference was statistically significant (P <0.05), and 10 minutes after extubation was no statistical difference significance (P>0.05). Compared with the former administration, although the patients'SBP and HR of group S during and after the tube extraction increased, but the difference was not statistically significant (P>0.05). And compared with the group F, group S patients'SBP and HR during and after extubation are differences at each time point, there was significant (P<0.05). About the affact of hemodynamics, the stability of the cycle of group S is better than group F, and both are better than group C, the difference was significant. Both sufentanil and fentanyl are able to provide a stable environment of the hemodynamic.2. Compared with the former administration, the cortisol concentrations of group C at T2 increased significantly (P<0.01). The cortisol of group F in extubation increased significantly (P<0.05), while group S was no significant change in cortisol concentration (P>0.05). Compared with group C, the plasma cortisol concentration of group F at T2 and T4 time point changes, and the change is significant (P<0.05).3. Compared with the patients of, group C, the recovery time of breathing, eyes-opening, command recovery time, the extubation time of group F and group S were slightly extended, but the difference was not statistically significant (P> 0.05), which means that sufentanil and fentanyl in the completion of surgery would not extended awakening and extubation time before the completion in patients.4. The index of CSI showed no significant difference in three groups, the time of respiration recovery, opening the eyes and trachea extubation prolong a little in F group and S group compared with R group, but also no significant difference.5. In the group C,5 patients had moderate agitation while 3 patients had abnormal restlessness during extubation. In group F and group S, the rate of agitation was lower than group C. In group F, two cases happened moderate agitation and 18 did not happen restlessness. In the group S, one case happened moderate agitation while 19 didn't. Between group F and group C, there was significant difference in agitation rate (P<0.05). Between group S and group C, there was significant difference in agitation rate(P<0.05), but between group F and group S, there was no difference.6. The incidence of shivering in group F and group S was significantly lower than group C (P<0.05). But between groups S and group F, there was not significant difference in the incidence of shiver (P>0.05). There was not difference in incidence of nausea and vomiting after extubation in three groups. In respiratory depression, drowsiness and other side effects, there was no significant differences in three groups.Conclusion:small dose of fentanyl and sufentanil be used for postoperative extubation can inhibit extubation of the stress response.sufentanil can be more effective. Sufentanil and fentanyl were both effective in the early analgesic effect. Both of them can prevent cardiovascular responses and inhibit the stress response during tracheal extubation. In the inhibition of shock response, sufentanil is better than fentanyl.