The Effect of Intraoperative Use of High-Dose Remifentanil on Postoperative Insulin Resistance and Muscle Protein Catabolism: A Randomized Controlled Study

Abstract

Objective: We investigated the effect of the intraoperative use of a high dose remifentanil on insulin resistance and muscle protein catabolism.Design: Randomized controlled study.Patients and Intervention: Thirty-seven patients undergoing elective gastrectomy were randomly assigned to 2 groups that received remifentanil at infusion rates of 0.1 μg·kg-1·min-1 (Group L) and 0.5 μg·kg-1·min-1 (Group H).Main outcome measures: Primary efficacy parameters were changes in homeostasis model assessment as an index of insulin resistance (HOMA-IR) and 3-methylhistidine/creatinine (3-MH/Cr). HOMA-IR was used to evaluate insulin resistance, and 3-MH/Cr was used to evaluate the progress of muscle protein catabolism. Intraoperative stress hormones, insulin, and blood glucose were assessed as secondary endpoints.Results: Eighteen patients in Group L and 19 in Group H were examined. HOMA-IR values varied within normal limits in both groups during surgery, exceeding normal limits at 12 h after surgery and being significantly elevated in Group L. There were no significant differences in the 3-MH/Cr values between the 2 groups at any time point. The stress hormones (adrenocorticotropic hormone, cortisol, and adrenaline) were significantly elevated in Group L at 60 min after the start of surgery and at the initiation of skin closure. There were no significant differences in insulin values, but blood glucose was significantly elevated in Group L at 60 min after the start of surgery and at the start of skin closure.Conclusion: Use of high-dose remifentanil as intraoperative analgesia during elective gastrectomy reduced postoperative insulin resistance, although it did not reduce postoperative muscle protein catabolism.

The Effects of Glucose Load on Catabolism during Remifentanil-Based Anesthesia in Patients with Diabetes Mellitus: A Prospective Randomized Trial

“…Thus, our results suggest that remifentanil itself is a strong inhibitor of surgical stress responses, including protein sparing. The continuous infusion of high-dose remifentanil during elective gastrectomy was recently shown to reduce postoperative insulin resistance compared with the use of low-dose remifentanil, while postoperative muscle protein catabolism was unchanged [9]. Taken together, these results suggest that remifentanil has an inhibitory effect on insulin tolerance and protein sparing, possibly by inhibiting the production of stress hormones.…”

Drug-induced HPA axis alterations during acute critical illness: a multivariable association study

“…The magnitude of the effect of opioids was large and dose‐dependent. Acute opioid administration to healthy individuals, prolonged opioid administration to patients suffering from chronic pain and intraoperative intravenous opioid administration in surgical patients have been shown to result in suppressed plasma ACTH and/or cortisol concentrations . Effects on the hypothalamus and pituitary are assumed to mediate such an effect of opioids on the HPA axis most likely via the κ opioid receptor .…”

The effect of perioperative glucose control on postoperative insulin resistance

“…Opioids used during general anesthesia may blunt the metabolic response during surgery 142 . A similar effect was demonstrated for Propofol at single use.…”