The effects of fentanyl and remifentanyl on the surgical stress response in patients undergoing cholecystectomy operation with sevoflurane anaesthesia

Objective: In this study, the effects of fentanyl and remifentanyl on the surgical stress response in patients undergoing cholecystectomy operation were compared.
Study design: 35 patients with ASA I-II physical status undergoing cholecystectomy were included in this study. The same general anaesthesia was given to patients which were double blind randomly divided into two groups. Group F (n=18) had Imcglkg fentanyl and until 20 seconds before the end of surgery lmcg/kg/h fentanyl was infused. Group R (n=17) had lmcg/kg remifentanil and until the end of surgery 0. 25mcg/kglmin remifentanyl was infused. MABP, HR values and blood cortisol, insuline, glucose, ACTH and GH levels were measured in four periods: 1. before the induction of anaesthesia, 2. before the surgical incision, 3. 10 minutes after the incision and 4. 20 minutes after extubation.
Results: During 2. and 3. period MABP, HR values were lower in Group R compared with Group F (p<0.05) and blood cortisol level was lower during 2. and 3. period in comparison with the first period. (p<0.001) There was no difference in the other stress parameters between the 2 groups
Conclusion: During cholecystectomy, remifentanyl provided more stable hemodynamics compared with fentanyl. There was no difference in stress response between the 2 groups and neither remifentanyl nor fentanyl was able to abolish stress response.

Kolesistektomi operasyonu uygulanan hastalarda sevofluran anestezisi altýnda remifentanil ile fentanilin cerrahi stres yanýt üzerine etkilerinin karþýlaþtýrýlmasý

Amaç: Bu çalýþmada kolesistektomi operasyonu uygulanan hastalarda remifentanil ile fentanilin cerrahi stres yanýt üzerine etkilerinin karþýlaþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Çalýþma, kolesistektomi operasyonu planlanan ASA I-II grubundan 35 olgu üzerinde yapýlmýþtýr. Randomize ve körleme olarak iki gruba ayrýlan olgulara ayný genel anestezi verildi. Grup F’ye (n-18) lmcg/kg fentanil verildi ve tahmini cerrahi bitiþ süresinden 20 dakika önceye kadar Ýmcglkglh infüzyon yapýldý. Grup R’ye (n=17) Ýmcglkg remifentanil verildi ve cilt sütürüne kadar 0,25Ýmeg/kg/min infüzyon yapýldý. 4 ölçüm zamanýnda (1.anestezi indüksiyonundan hemen önce, 2. cerrahi insizyondan önce, 3. insizyondan 10 dakika sonra, 4. ekstübasyondan 20 dakika sonra), OAB, KTA, kortizol, insülin, glikoz, ACTH ve GH deðerleri kaydedildi.
Bulgular: Grup R’de 2. ve 3. ölçüm zamanlarýnda OAB, KTA grup F’ye göre anlamlý düþük bulundu (p<0.05). Kortizol deðeri Grup R’de 2. ve 3. ölçüm zamanlarýnda baþlangýç deðerlerine göre ileri derecede anlamlý düþük bulundu (p<0.001). Her iki grup arasýnda insülin, glikoz, ACTH ve GH deðerleri açýsýndan anlamlý fark bulunmadý.

Sonuç: Remifentanil, cerrahi sýrasýnda fentanilden daha iyi hemodinamik stabilité saðlamýþtýr. Her iki grupta da cerrahiye stres yanýtta benzer etkiler görülmüþ, stres cevap köreltilememiþtir.