Effect On Stress Reaction During Intubation And Cytokines On Perioperative In Patients After Hydromorphone-based Anesthesia

Objective:To evaluate the effect on stress reaction during intubation and cytokines on perioperative in patients after hydromorphone-based anesthesia.Methods:Sixty patients, aged 20-65 yr, BMI 19~29 kg/m2, of ASA physical statusⅠorⅡ, scheduled for elective oral and maxillofacial surgery, were randomly divided into two groups(n=30 each) : hydromorphone group(group H) and fentanyl group(group F).Patients after establishing peripheral venous access were infused fentanyl 4 μg/kg in group F and hydromorphone 0.5 mg in group H. Followed by continuous infusion intravenously midazolam 0.04 mg/kg, propofol 1.0~2.0 mg/kg and atracurium 0.20~0.25 mg/kg were given after 10 min. And then remifentanil 0.1~0.2 μg·kg-1·h-1 and propofol 3~5 mg·kg-1·h-1 were infused continuously which was maintained until skin closure.Heart rate(HR), and mean arterial pressure(MAP) were recorded at different time points as follows: baseline values were recorded after arrivalling operation room 5 min(T0), befor intubation(T1), immediately after intubation(T2) and at 1,3,5 and 10 min after intubation(T3-6). Enzyme-linked immunosorbent assay(Elisa) was adopted to detect the concentrations of epinephrine(E), norepinephrine(NE), C-reactive protein(CRP) and cortisol(Cor) at T0,2,5,6. The concentrations of IL-6, IL-10 and TNF-α were detected at different time points as follows: T0, the moment of cutting duramater(T1), 30 minafter cutting duramater(T2) and 1 hour after surgery(T4).The time of operation, anesthesia awake, extubation and the consumption of propofol and remifentanil were recorded; emergence agitation and breathing forgotten, nausea and pruritus during postoperation were oberserved and recorded.Results:1 Between the two groups of patients age,gender ratio,weight, the time of operation and the consumption of propofol and remifentanil, there was no significant difference(P>0.05).2 The comparison of hemodynamics2.1 The influence on the MAP of group F was significant greater than group H(P<0.05). Compared with T0, the MAP of group H at Tl, 5, 6 were lower, at T2 was higher(P<0.05); Compared with T0, the MAP of group H at Tl was lower, at T2 was higher(P<005), the MAP of group F at T3-6 was no significant difference(P>0.05). Compared with F, the MAP of group H at T1,5,6 were higher(P<0.05), at T0,2-4 was no significant difference(P>0.05).2.2 The influence of group F on HR was significant greater than group H(P<0.05). Compared with T0, the HR of group F at Tl,6 were lower(P<0.05), the HR of group F at T0,2-5 was no significant difference(P>0.05). Compared with T0, the HR of group H at T2 was higher(P<0.05), the HR of group H at T0,1,3-6 was no significant difference(P>0.05). Compared with F, the HR of group H at T1,6 were higher(P<0.05), the HR of group H at T0,2-5 was no significant difference(P>0.05).3 The comparison of stress factors3.1 Compared with T0, the concentration of E in group F at T2,5 were higher(P<0.05). Compared with T0, the concentration of E in group H at T2 was lower, at T5 was higher(P<0.05). Compared with group F, the concentration of E in the group H at T2,5 were lower(P<0.05).3.2 Compared with T0, the concentration of NE in group F at all times we recoreded were higher(P<0.05). Compared with T0, the concentration of NE in group H at T2,5 were higher(P<0.05). Compared with group F, the concentration of NE in the group H at all times we recoreded were lower(P<0.05).3.3 Compared with T0, the concentration of CRP in group F and group H at T5 were higher(P<0.05). Compared with group F, the concentration of CRP in the group H was no significant difference(P>0.05).4 The comparison of cytokinesCompared with T0, the concentration of IL-6 and TNF-α in group F and H at T7-9 were higher, the concentration of IL-10 in group F and H at T8,9 was higher(P<0.05). Compared with group F, the concentration of IL-6 and TNF-α in the group H at T7-9 were lower, but the concentration of IL-10 at T8,9 was higher(P<0.05).5 The comparison of vascular active drug and postoperative side effectsCompared with group F, the probability of using atropine, emergence agitation and breathing forgotten were lower(P<0.05).Conclusion:1 Hydromorphone can be used in oral and maxillofacial surgery safely, and reduced the stress response caused by tracheal intubation of general anesthesia.2 Hydromorphone through regulating the level of cytokines could inhibit systemic inflammatory response syndrome.3 Hydromorphone can reduce the risk of postoperative and make patients comfortable by reducing postoperative side effects after hydromorphone-based anesthesia.