[Endocrine stress parameters during TIVA with remifentanil or sufentanil]

Area of Science:

• Anesthesiology
• Endocrinology
• Cardiovascular Physiology

Background:

• Anesthetic management of surgical stress involves monitoring endocrine and cardiovascular responses.
• Opioid analgesics like remifentanil and sufentanil are used in total intravenous anesthesia (TIVA) for procedures such as retinal surgery.
• Individual anesthetic agents can elicit distinct endocrine and hemodynamic reactions.

Purpose of the Study:

• To compare the endocrine stress responses and hemodynamic reactions to remifentanil versus sufentanil during TIVA for retinal surgery.
• To evaluate the effectiveness of these opioids in suppressing the endocrine stress response to surgical stimulation.

Main Methods:

• A patient-blind, randomized, prospective study included 22 patients undergoing retinal surgery.
• Patients received TIVA with propofol and either remifentanil (R-group) or sufentanil (S-group).
• Hormone levels (prolactin, growth hormone, cortisol, epinephrine, norepinephrine) and hemodynamic parameters were measured before anesthesia, during surgery, and after extubation.

Main Results:

• Prolactin levels increased significantly in both groups, with a greater increase observed in the sufentanil group.
• Cortisol and norepinephrine levels decreased significantly in both groups during surgery.
• Growth hormone and epinephrine levels decreased significantly only in the sufentanil group, while remaining unchanged in the remifentanil group.
• Blood pressure decreased by approximately 30% in both groups; heart rate tended to be lower in the remifentanil group.

Conclusions:

• Both remifentanil and sufentanil provide effective suppression of the noxious stimulation-induced endocrine stress response during retinal surgery.
• The observed increase in prolactin may be related to mu 1-receptor stimulation.
• The differential effects on other stress hormones suggest nuanced endocrine modulation by each opioid.