Comparison of recovery effect for sufentanil and remifentanil anesthesia with TCI in laparoscopic radical resection during colorectal cancer

Abstract

The aim of the present study was to compare the recovery of sufentanil and remifentanil anesthesia by target-controlled infusion (TCI) in elderly patients with laparoscopic-assisted radical resection of colorectal cancer. The effect of anesthesia on patient stress response and cellular immune function was also observed. Elderly patients (n=192) who underwent laparoscopic radical resection of colorectal cancer between July 2014 and October 2015 were randomly divided into the sufentanil and remifentanil groups (n=96 per group). The two groups used sufentanil- and remifentanil-based anesthesia by TCI. The wake-up time, extubation time, orientation recovery time, vital signs, stress response, distribution of T-cell subsets and incidence of adverse reactions were recorded and compared. The wake-up and extubation times of the remifentanil group were significantly shorter than those of the sufentanil group. The difference of orientation recovery time was not statistically significant. The differences in heart rate, mean arterial pressure, and arterial oxygen saturation following anesthesia and during surgery and those prior to anesthesia of the sufentanil group were not statistically significant. However, those of the remifentanil group significantly improved following anesthesia. The concentrations of glucose, cortisol (COR), and interleukin-6 and C-reactive protein were stable in the sufentanil group, whereas the indices in the remifentanil group had a tendency of increasing during the anesthesia and surgery, and had a longer postoperative recovery time. The decreasing degree of T-cell subsets in the sufentanil group was significantly lower than that in the remifentanil group, and had a short recovery of cellular immunity following surgery. The adverse reactions rate during anesthesia of the remifentanil group was significantly higher than that of the sufentanil group. In conclusion, sufentanil- and remifentanil-based anesthesia with TCI has certain advantages, including improved recovery effect, less stress response, less inhibition of cellular immunity and fewer adverse reactions. It has the potential to become the first choice of anesthetic in the clinic for elderly patients who undergo laparoscopic radical resection for colorectal cancer.

Effects of surgery and anesthetic choice on immunosuppression and cancer recurrence

“…Alfentanil decreases NK cell activity [ 52 ], and remifentanil has demonstrated suppression of NK cell activity and lymphocyte proliferation in a rat model [ 58 ]. A comparison of sufentanil and remifentanil using target-controlled infusion during laparoscopic colorectal cancer resection showed that cortisol and IL-6 increased more in the remifentanil group and that the proportion of T cell subsets decreased more in the sufentanil group [ 59 ].…”

<p>Effects of Additional Intraoperative Administration of Sufentanil on Postoperative Pain, Stress and Inflammatory Responses in Patients Undergoing Laparoscopic Myomectomy: A Double-Blind, Randomized, Placebo-Controlled Trial</p>

“…40 Proper analgesic regimens can prevent both peripheral and central sensitization, thereby attenuating the postoperative amplification of pain sensation and consequently reducing postoperative stress and inflammatory response. 43,44 The levels of stress hormones and inflammatory mediators in our study were significantly lower in group T compared with group C at 1h in the PACU. This result is consistent with our findings of postoperative VAS pain scores.…”

Sufentanil postoperative analgesia reduce the increase of T helper 17 (Th17) cells and FoxP3+ regulatory T (Treg) cells in rat hepatocellular carcinoma surgical model: A randomised animal study

“…Sufentanil increased the quantity of the Tregs to a greater degree than fentanyl when the culturing was conducted in vitro, while there was no significant difference between them in vivo [34]. In a clinical trial, total CD3 + , CD4 + , CD8 + cells and the ratio of CD4 + /CD8 + cells in the sufentanil group were significant higher than that in the remifentanil group [35]. There are few direct comparative studies which involved in the effects of sufentanil and morphine on immunity.…”