Comparison of hemodynamic and endocrine stress response of remifentanil and sufentanil during cardiac surgery with cardiopulmonary bypass

  AIM  To observe and compare the effects of two analgesic methods of remifentanil or sufentanil on hemodynamics and endocrine stress response during cardio surgery with cardiopulmonary bypass (CPB).

  METHODS  Forty patients undergoing elective cardiopulmonary bypass surgery, ASA Ⅲ-Ⅳ, were randomly divided into remifentanil TCI group (group R) and sufentanilbolus injection group (group S). After induction of anesthesia, the group R was treated with remifentanil TCI and the concentration of the drug in the effect mode was 6-8 ng/ml. The group S was intermittently given sufentanil 50 ug. In both groups, sevoflurane was used to maintain BIS 40-50 and cisatracuriumbesilate was used to maintain muscle relaxation. 5 ml of venous blood at different time points were collected for the determination of ACTH, Cor, C3a, IL-6, IL-10 and TNF-α, and hemodynamic indexes at different time points were monitored in both groups.

  RESULTS  At the beginning of CPB, MAP in the group R was significantly higher than that in the group S (70 ± 5 mmhg vs. 62 ± 5 mmhg, P < 0.05), but MAP in the group R fluctuated less. The extubation time in group R was less than that in group S (187 ± 102 min vs. 298 ± 157 min, P < 0.05). ACTH in group R was significantly lower than that in group S (P < 0.05). After 15 minutes of protamine neutralization, the levels of Co, IL-6 and TNF-α in group R were significantly lower than those in group S (P < 0.05).

  CONCLUSION  During cardiac surgery with cardiopulmonary bypass, compared with sufentanil bolus injection, remifentanil TCI stabilizes the patient’s intraoperative hemodynamics, lowers endocrine stress and significantly reduces postoperative tracheal extubation time.