Comparison of the effects of fentanyl and remifentanil on splanchnic tissue perfusion during cardiac surgery

Bedirli, Nurdan; Boyacı, Adem; Akın, Aynur; Esmaoğlu, Aliye

doi:10.1007/s00540-006-0457-y

Cited by 7 publications

(3 citation statements)

References 17 publications

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“…Furthermore, fentanyl has been commonly used for patients undergoing cardiac operations because high doses of fentanyl can stabilize the cardiovascular circulatory system during operations. After administration of 50-100 μg/kg fentanyl, the plasma concentration of fentanyl in these patients is commonly above 20-30 ng/mL [9] . However, high plasma concentrations of fentanyl are associated with clinical side effects such as nausea and vomiting, constipation, skin itching and respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

Fentanyl inhibits glucose-stimulated insulin release from β-cells in rat pancreatic islets

Qian¹,

Wang²,

Liu³

et al. 2009

WJG

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AIM:To explore the effects of fentanyl on insulin release from freshly isolated rat pancreatic islets in static culture. METHODS:Islets were isolated from the pancreas of mature Sprague Dawley rats by common bile duct intraductal collagenase V digestion and were purified by discontinuous Ficoll density gradient centrifugation. The islets were divided into four groups according to the fentanyl concentration: control group (0 ng/mL), group Ⅰ (0.3 ng/mL), group Ⅱ (3.0 ng/mL), and group Ⅲ (30 ng/mL). In each group, the islets were co-cultured for 48 h with drugs under static conditions with fentanyl alone, fentanyl + 0.1 μg/mL naloxone or fentanyl + 1.0 μg/mL naloxone. Cell viability was assessed by the MTT assay. Insulin release in response to low and high concentrations (2.8 mmol/L and 16.7 mmol/L, respectively) of glucose was investigated and electron microscopy morphological assessment was performed. RESULTS:Low-and high-glucose-stimulated insulin release in the control group was significantly higher than in groups Ⅱ and Ⅲ (62.33 ± 9.67 μIU vs 47.75 ± 8.47 μIU, 39.67 ± 6.18 μIU and 125.5 ± 22.04 μIU vs 96.17 ± 14.17 μIU, 75.17 ± 13.57 μIU, respectively, P < 0.01) and was lowest in group Ⅲ (P < 0.01). After adding 1 μg/mL naloxone, insulin release in groups Ⅱ and Ⅲ was not different from the control group. Electron microscopy studies showed that the islets were damaged by 30 ng/mL fentanyl. CONCLUSION:Fentanyl inhibited glucose-stimulated insulin release from rat islets, which could be prevented by naloxone. Higher concentrations of fentanyl significantly damaged β-cells of rat islets.

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Section: Introductionmentioning

confidence: 99%

Fentanyl inhibits glucose-stimulated insulin release from β-cells in rat pancreatic islets

Qian¹,

Wang²,

Liu³

et al. 2009

WJG

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“…Безпосередній вплив опіоїдів на спланхнічний кровоплин вивчений недостатньо. За даними Bedirli та ін., у пацієнтів, яким проводилось аортокоронарне шунтування, застосування опіоїдів призводило до погіршення показників спланхнічного кровоплину (pH та P CO 2 слизової шлунку) оціненого методом шлункової тонометрії, що автори частково пов'язували з депресією системної гемодинаміки [17]. За результатами нашого дослідження у дітей без ІАГ, з ІАГ та з АКС, що знеболювались пролонгованою інфузією морфіну спостерігались статистично значуще нижчі показники BFI SMA у порівнянні із групами «Лідокаїн» та «ЕДА» та статистично значуще нижчі показники BFI PV у дітей з ІАГ та з АКС у порівнянні з групою «ЕДА».…”

Section: вступunclassified

The Influence of Postoperative Analgesia Techniques on Splanchic Blood Flow in Children With Intraabdominal Hypertension

Перова-Шаронова¹

2021

Pain Anaesth Int Care

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Introduction. Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) often develop in critically ill patients and can lead to affected splanchnic blood flow, intestinal mucosal ischemia, bacterial translocation, sepsis, and multiorgan dys-function. There is limited literature data on the effect of analgesic methods on splanchnic blood flow in IAG / AСS. The aim of the study was to define the effect of different postoperative analgesia techniques on splanchnic blood flow in children with appendicular peritonitis with IAH. Materials and methods. The study included 115 children who underwent surgery for appendicular peritonitis. Children were randomized into three groups depending on the method of postoperative analgesia: “Opioids” (n = 36; intravenous infusion of morphine 10 μg/kg/h); “Lidocaine” (n = 40; intravenous infusion of lidocaine 1.5 mg/kg/h); “EDA” (n = 39; epidural infusion 0.25% bupivacaine 0.4 mg/kg/h). Postoperatively intraabdominal pressure (IAP) was measured 4 times a day using the standard in-direct method through a Foley catheter in the bladder. According to the IAP level and presence of organ dysfunction patients in each group were divided in subgroups: “Without IAH”, “IAH” and “ACS”. The diameters and linear velocities of blood flow in the superior mesenteric artery (SMA) and portal vein (PV) were detected using US. The blood flow indices in SMA and PV (BFISMA, BFIPV, ml/min/m2) were calculated. Results. BFISMA and BFIPV were significantly higher in children without IAH than in children with IAH (p <0.0001) and ACS (p <0.0001). Among patients in all subgroups, BFISMA was significantly higher in the groups “Lidocaine” (p <0.05) and “EDA” (p <0.0001) compared with the group “Opioids”. BFIPV was higher in the group “EDA” (p <0.05) in children with IAH and in the groups “Lidocaine” (p <0.0001) and “EDA” (p <0.0001) in children with ACS compared with children of all subgroups in the group “Opioids”. Among the children without IAH a statistically significant negative correlation between IAP and BFISMA was observed only in the group “Opioids” (rs = -0.5; p <0.001). Among the children with IAH and ACS, a statistically significant negative correlation between IAP and BFISMA was observed in all analgesia groups, but it was weakest in the group “EDA” (rs = -0.24; p <0.04 and rs = -0.39; p <0.05, respectively). In the group “Opioids” a statistically significant negative correlation between IAP and BFIPV was observed only in the children with IAH (rs=-0.31; p<0.01) and ACS (rs=-0.4; p<0.0001). Conclusions. Epidural analgesia is the most optimal method of analgesia for the effect on impaired splanchnic blood flow in children with peritonitis complicated with intra-abdominal hypertension. Intravenous analgesia with lidocaine may be an alternative to epidural anesthesia.

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“…Remifentanil has gained increased attention due to its possible fast-track potential with shorter ventilation time, shorter admission in the ICU [6,7] and improved postoperative quality [8]. However, some studies have shown less haemodynamic stability after remifentanil compared to other opioids [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Remifentanil and Sufentanil Preserve Left Ventricular Systolic and Diastolic Function in Patients with Ischemic Heart Disease-A Randomised Comparative Study

Frederiksen¹

2014

J Anesth Clin Res

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Although the impact of drugs on cardiac function seems unchanged by standard haemodynamic measurements, it might be followed by injurious stress and deterioration of myocardial function as stable conventional monitoring not necessarily represent unaffected function. The aim of the study was to assess changes in global haemodynamic measures, primarily by changes in cardiac index, and contemporary indices of LV systolic and diastolic function during induction of anaesthesia with remifentanil compared to sufentanil. The aim was to compare the effect of sufentanil and remifentanil with primary focus on the opioids given as a single drug and secondary in conjunction with Propofol. Methods: Thirty patients with ischaemic heart disease scheduled for elective cardiac surgery were randomized to receive either remifentanil or sufentanil as basic opioid. Cardiac function was evaluated with invasive haemodynamic measures established before administration of the opioids, combined with echocardiographic left ventricular systolic (longitudinal peak systolic strain) and diastolic function (tissue Doppler-index, E/e'). Results: In single drug administration, no differences were found in cardiac index (CI), stroke volume index (SVI) and heart rate (HR) between the opioids. A minor fall was seen in mean arterial blood pressure (MAP) after remifentanil (104 ± 14 to 91 ± 15 mmHg; P=0.001) and sufentanil (107 ± 21 to 94 ± 24 mmHg; P=0.003), with no difference between groups (P=0.933). Central venous pressure (CVP) increased after sufentanil (P=0.022) and mean pulmonary artery pressure (mPAP) in both groups. No changes were observed for cardiac index, stroke volume index and heart rate or in longitudinal peak strain (remifentanil-14.3 ± 4.0 to-16.3 ± 4.6; P=0.059 and sufentanil-14.5 ± 2.8 to-15.1 ± 2.3; P=0.469). After initiation of propofol all parameters declined over time. Remifentanil patients had lower MAP (P<0.001) and CVP (P=0.003), while heart rate (P=0.025) was higher. No other statistically significant differences between the groups. Conclusions: In a single drug setting, the haemodynamic effects of remifentanil are comparable to sufentanil in ischaemic patients. Combined with propofol, identical greater changes are seen in especially MAP, HR and SVI in both groups, likely designated to propofol and its combination with opioids. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

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Comparison of the effects of fentanyl and remifentanil on splanchnic tissue perfusion during cardiac surgery

Cited by 7 publications

References 17 publications

Fentanyl inhibits glucose-stimulated insulin release from β-cells in rat pancreatic islets

Fentanyl inhibits glucose-stimulated insulin release from β-cells in rat pancreatic islets

The Influence of Postoperative Analgesia Techniques on Splanchic Blood Flow in Children With Intraabdominal Hypertension

Remifentanil and Sufentanil Preserve Left Ventricular Systolic and Diastolic Function in Patients with Ischemic Heart Disease-A Randomised Comparative Study

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