Abstract
:Background:Maintaining blood pressure (BP) and heart rate (HR) after laryngoscopy and tracheal intubation has always been a concern in injured patients. Opioids can attenuate or stop an increase in these two parameters if administered with proper doses or targets in target-controlled infusion (TCI). Remifentanil and sufentanil are widely used for this purpose because their cardiac side effects are low and, especially in traumatic patients, they are tolerated well. A comparison of the benefits and limitations of these two opioids in TCI is much needed. A literature review in electronic data bases revealed few results. Methods:40 normotensive patients were enrolled to this randomized clinical trial study. After BIS guided anesthesia with a target-controlled propofol infusion and muscle relaxation with cisatracurium, remifentanil and sufentanil were infused using TCI with 2 and 0.2 ng.ml-1 targets respectively. BP and HR were recorded for five data points and compared with Fischer's exact test. Results:Systolic, mean and diastolic arterial pressure and HR in different points of the study remained below baseline values but were out of control in some cases, however the out-of-control values showed significant difference between the two groups only for heart rate changes. The relative risk for producing out-of-control changes with remifentanil compared to sufentanil is significantly more than 1 for HR decrease. Conclusions:Sufentanil produced more common pre-intubation hypotension than remifentanil in propofol anesthetized patients but this hypotension disappeared sooner than remifentanil after tracheal intubation. Both opioids prevent an increase in BP and HR after tracheal intubation but the side effects (hypotension and bradycardia) may be a cause for concern (IRCT138710011361N3).
Highlights
Blood pressure and heart rate are among the most widely used hemodynamic parameters during anesthesia and surgery to evaluate cardiovascular status and in traumatic injured patients to preserve these hemodynamic parameters in physiological ranges are important
There are other parameters such as stroke volume, cardiac index and systemic vascular resistance which are more important for this evaluation, they have more limited use in daily clinical anesthesia practice; blood pressure (BP) and heart rate (HR) are the clues for further cardiovascular assessment during anesthesia
Mean and diastolic arterial pressure and heart rate in different points of the study remained below baseline values but were out of control in some cases which are shown in Figures 1 and 2, the out-ofcontrol values showed significant differences between
Summary
Blood pressure and heart rate are among the most widely used hemodynamic parameters during anesthesia and surgery to evaluate cardiovascular status and in traumatic injured patients to preserve these hemodynamic parameters in physiological ranges are important. 5 Many opioids such as fentanil, alfentanil, sufentanil and remifentanil have an important role in controlling changes in hemodynamic variables in response to tracheal intubation.[3,6,7] Remifentanil on the other hand is one of the newest synthetic opioids with unique characteristics which makes it ideal for the perinduction period in anesthesia mainly a short onset and the fastest offset among anilidopiperidine family,[8,9] conventional administration of these opioids should be timed so their maximum effects are predictably matched with the stimuli. Both opioids prevent an increase in BP and HR after tracheal intubation but the side effects (hypotension and bradycardia) may be a cause for concern (IRCT138710011361N3)
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