Comparison of the Effects of Remifentanyl-Propofol and Remifentasnyl-Isoflurane on Hemodynamic Variables, Blood Gases, and Blood Glucose among Patients under General Anesthesia

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: This study aimed to compare the effects of remifentanyl-propofol and remifentasnyl-isoflurane on hemodynamic variables, blood gases, and blood glucose among patients under general anesthesia.Methods: In a clinical trial study, 110 patients under neurosurgeries with general anesthesia were selected and randomly divided in to two groups. Continuing of anesthesia in the first and second groups was done by remifentanyl-propofol and remifentasnyl-isoflurane, respectively. The changes of hemodynamic variables, blood gases, and blood glucose were compared between the two groups.Findings: The mean blood glucose level in the first hour was significantly more in remifentanyl-propofol group (114.3 ± 44.5 mg/dl) compared to remifentasnyl-isoflurane group (94.7 ± 26.9 mg/dl) (P = 0.006); the mean blood glucose levels in the second and third hours were significantly more in remifentanyl-propofol group, too (P < 0.001 for both). In addition, mean blood pressure levels was significantly more in remifentanyl-propofol group (P < 0.050 for all); but blood gases analysis did not show any statistically difference between the groups.Conclusion: Using remifentanyl + isoflurane in patients underwent neurosurgery with general anesthesia led to better blood glucose and blood pressure levels and using this compound is recommended.

Keywords


  1. Vahabi S, Sharafi M, Yari F. Comparative study of post operative stress response between general and spinal anesthesia in gynecologic surgeries. Yafteh 2009; 11(3): 15-22. [In Persian].
  2. Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, editors. Miller's anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone; 2011.
  3. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc 2005; 80(7): 862-6.
  4. Kitamura T, Ogawa M, Kawamura G, Sato K, Yamada Y. The effects of sevoflurane and propofol on glucose metabolism under aerobic conditions in fed rats. Anesth Analg 2009; 109(5): 1479-85.
  5. Weale NK, Rogers CA, Cooper R, Nolan J, Wolf AR. Effect of remifentanil infusion rate on stress response to the pre-bypass phase of paediatric cardiac surgery. Br J Anaesth 2004; 92(2): 187-94.
  6. Tanaka T, Nabatame H, Tanifuji Y. Insulin secretion and glucose utilization are impaired under general anesthesia with sevoflurane as well as isoflurane in a concentration-independent manner. J Anesth 2005; 19(4): 277-81.
  7. Carles M, Dellamonica J, Roux J, Lena D, Levraut J, Pittet JF, et al. Sevoflurane but not propofol increases interstitial glycolysis metabolites availability during tourniquet-induced ischaemia-reperfusion. Br J Anaesth 2008; 100(1): 29-35.
  8. Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology 1992; 76(5): 725-33.
  9. Fredman B, Nathanson MH, Smith I, Wang J, Klein K, White PF. Sevoflurane for outpatient anesthesia: a comparison with propofol. Anesth Analg 1995; 81(4): 823-8.
  10. Dashfield AK, Birt DJ, Thurlow J, Kestin IG, Langton JA. Recovery characteristics using single-breath 8% sevoflurane or propofol for induction of anaesthesia in day-case arthroscopy patients. Anaesthesia 1998; 53(11): 1062-6.
  11. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand 2000; 44(3): 307-10.
  12. Ihn CH, Joo JD, Choi JW, Kim DW, Jeon YS, Kim YS, et al. Comparison of stress hormone response, interleukin-6 and anaesthetic characteristics of two anaesthetic techniques: volatile induction and maintenance of anaesthesia using sevoflurane versus total intravenous anaesthesia using propofol and remifentanil. J Int Med Res 2009; 37(6): 1760-71.
  13. Grundmann U, Risch A, Kleinschmidt S, Klatt R, Larsen R. Remifentanil-propofol anesthesia in vertebral disc operations: a comparison with desflurane-N2O inhalation anesthesia. Effect on hemodynamics and recovery. Anaesthesist 1998; 47(2): 102-10. [In German].
  14. Juckenhofel S, Feisel C, Schmitt HJ, Biedler A. TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects. Anaesthesist 1999; 48(11): 807-12. [In German].
  15. Mujagic Z, Cicko E, Vegar-Brozovic V, Praso M. Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl. Cent Eur J Med 2008; 3(4): 459.
  16. Schricker T, Carli F, Schreiber M, Wachter U, Geisser W, Lattermann R, et al. Propofol/sufentanil anesthesia suppresses the metabolic and endocrine response during, not after, lower abdominal surgery. Anesth Analg 2000; 90(2): 450-5.
  17. Farrokhnia F, Lebaschi AH, Andalib N. A randomized clinical trial for the effects of halothane and isoflurane anesthesia on blood glucose levels in the diabetic patients. DARU J Pharm Sci 2009; 17(1): 29-32.
  18. NG A, Tan SS, Lee HS, Chew SL. Effect of propofol infusion on the endocrine response to cardiac surgery. Anaesth Intensive Care 1995; 23(5): 543-7.