Email updates

Keep up to date with the latest news and content from BMC Anesthesiology and BioMed Central.

Open Access Highly Accessed Research article

Effect of remifentanil infusion rate on stress response in orthopedic surgery using a tourniquet application

Taketo Shinoda*, Wakako Murakami, Yasuo Takamichi, Hiroki Iizuka, Masaaki Tanaka and Yuto Kuwasako

Author Affiliations

Department of Anesthesiology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-8501, Japan

For all author emails, please log on.

BMC Anesthesiology 2013, 13:14  doi:10.1186/1471-2253-13-14

Published: 10 July 2013

Abstract

Background

Currently, in the field of general anesthesia, balanced anesthesia in combination with analgesic, hypnotic, and muscle relaxant is commonly used. Remifentanil is the standard analgesic used in balanced anesthesia, and has contributed greatly to reduce the physical stress of the patient during surgery. We compared the stress response suppression effect of remifentanil by measuring stress hormones in 2 groups treated with different analgesic doses in orthopedic surgery using a tourniquet.

Methods

Twenty patients were randomly divided into 2 groups (10 patients each) undergoing maintenance of general anesthesia with 0.25 μg/kg/min remifentanil and sevoflurane (Group A) and 1.0 μg/kg/min remifentanil and sevoflurane (Group B). Hemodynamic changes, adrenocorticotropic hormone (ACTH), cortisol, antidiuretic hormone (ADH), adrenaline (Ad), noradrenaline (NAd), dopamine (DOA), insulin, and blood glucose were measured at the initiation of general anesthesia,10 minutes after the initiation of tourniquet application, and immediately before and 10 minutes after the completion of tourniquet application.

Results

ACTH, cortisol, ADH, Ad, and NAd levels in Group B were significantly lower (ACTH and cortisol: P < 0.01, ADH, Ad, and NAd: P < 0.05) than those in Group A. No significant differences were noted in DOA, insulin, or blood glucose levels between the groups.

Conclusion

Anesthesia management with high-dose remifentanil (1.0 μg/kg/min) suppressed intraoperative tourniquet pain-induced stress hormone release, suggesting its usefulness in stabilizing hemodynamics.

Trial registration

JMA-IIA00094

Keywords:
Tourniquet pain; Remifentanil; Stress response