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Remifentanil increases the incidence of mesenteric traction syndrome: preliminary randomized controlled trial
Yuki Nomura1, Yusuke Funai, Yohei Fujimoto
1Department of Anesthesiology, Sumitomo Hospital, 5-3-20 Nakanoshima, Kita-ku, Osaka 530-0005, Japan. qq572hz99@tea.ocn.ne.jp
Purpose:
The use of remifentanil is often associated with the observation of mesenteric traction syndrome (MTS) soon after manipulation of the intestine during abdominal surgery. MTS symptoms include facial flushing, hypotension, and tachycardia. In the study reported here, we prospectively investigated the effects of remifentanil on the incidence of MTS in abdominal surgery.
Methods:
One hundred patients scheduled for abdominal surgery were randomly assigned to two groups. In one group (n = 50), fentanyl alone was used as intravenous analgesic (control, group C); in the second group (n = 50), both fentanyl and remifentanil were used (remifentanil group, group R). In all patients, anesthesia was induced with propofol and rocuronium and then maintained with sevoflurane inhalation. Remifentanil was continuously infused for patients in group R as an analgesic. Plasma concentration of 6-keto-PGF(1α) was measured before surgery and 20 min after the skin incision was made in six patients of group R and seven patients of group C.
Results:
MTS occurred in 20 cases in group R (40.0%), but in only five cases in group C (10.0%). In both groups, the incidence of MTS was higher in laparotomy than in laparoscopic surgery. The plasma concentration of 6-keto-PGF(1α) was low in both groups before surgery and was elevated 20 min after skin incision in both groups in patients in whom MTS appeared.
Conclusions:
The results of this study suggest that the use of remifentanil in laparotomy facilitates MTS.
Insights
Remifentanil use during abdominal surgery significantly increases the risk of mesenteric traction syndrome (MTS), a condition characterized by hypotension and tachycardia. This study found MTS occurred in 40% of patients receiving remifentanil compared to 10% in the control group.
Area of Science:
- Anesthesiology
- Surgical Complications
- Pharmacology
Background:
- Mesenteric traction syndrome (MTS) is a recognized complication during abdominal surgery, often linked to anesthetic agents.
- Symptoms of MTS include facial flushing, hypotension, and tachycardia, posing risks to patient stability.
Purpose of the Study:
- To prospectively investigate the impact of remifentanil on the incidence of mesenteric traction syndrome (MTS) in patients undergoing abdominal surgery.
- To compare the occurrence of MTS between patients receiving fentanyl alone versus fentanyl combined with remifentanil.
Main Methods:
- A prospective study involving 100 patients undergoing abdominal surgery, randomly assigned to two groups: fentanyl alone (control) or fentanyl with remifentanil infusion.
- Anesthesia was maintained with propofol, rocuronium, and sevoflurane. Plasma 6-keto-PGF(1α) levels were measured pre- and post-incision in a subset of patients.
Main Results:
- Mesenteric traction syndrome (MTS) occurred in 40% of patients in the remifentanil group (n=50) versus 10% in the control group (n=50).
- The incidence of MTS was higher in open laparotomy compared to laparoscopic procedures in both groups.
- Elevated plasma 6-keto-PGF(1α) levels were observed in patients experiencing MTS post-incision.
Conclusions:
- The findings suggest that remifentanil administration during abdominal surgery, particularly laparotomy, is associated with an increased incidence of mesenteric traction syndrome (MTS).
- Remifentanil may play a facilitative role in the development of MTS, warranting careful consideration in anesthetic management.
