The optimistic dose of sufentanil during perioperative period of gastrointestinal surgery with the guidance of enhanced recovery after surgery

Qi Zeyou; Ma Jun; Lin Duomao

doi:10.3760/cma.j.issn.1673-4777.2018.03.021

Abstract：Objective To investigate the effects of different doses of sufentanil on hemodynamic fluctuation,anesthetic dosage and anesthesia recovery quality in patients undergoing open gastrointestinal surgery.Methods Seventy patients undergoing radical resection of gastrointestinal carcinoma from May 2016 to July 2017in Beijing Anzhen Hospital,Capital Medical University were randomly divided into group A and group B,with 35 patients in each group.After the same anesthesia induction(sulfentanyl 0.5 μg/kg,etomidate 0.2 mg/kg,midazolam 0.05 mg/kg,vecuronium bromide 0.1 mg/kg),the group A group was added sufentanil 0.5 μg/kg and the group B was added 0.9％ sodium chloride injection before skin incision.Mean arterial pressure(MAP)and heart rate (HR) were recorded before induction (baseline level),after induction,after adding sufentanil/0.9％ sodium chloride injection,during incision,at the beginning of abdominal exploration,30,60,90,120 min after incision,at the end of operation,at the enter of post-anesthesia care unit (PACU),during anesthesia recovery,during extubation and at the discharge of PACU.Dosages of propofol and remifentanil during anesthesia and operation,scores of the Visual Analogue Scale (VAS) for pain and the Modified Observer's Assessment of Alertness/Sedation Scale after extubation,occurrence of agitation due to unbearable pain and use of analgesic tramadol,occurrence of postoperative complications were recorded.Results MAP and HR after induction and after adding sufentanil/0.9％ sodium chloride injection were significantly lower than the baselines(P ＜0.05),and there were no significant differences between groups(P ＞0.05).HR in group A during operation was significantly lower than the baseline;MAP and HR during incision,at the beginning of abdominal exploration and at the end of operation in group B were significantly higher than the baselines and those in group A(P ＜0.05).During anesthesia recovery,MAP was significantly higher than the baseline in both groups;MAP in group A was significantly lower than that in group B(P ＜0.05).Dosage of remifentanil in group A was significantly less than that in group B[(0.80 ±0.07)mg vs (1.22 ±0.34)mg] (P ＜0.05).The VAS scores in group A were significantly lower than those in group B [at rest:(2.6 ± 0.9) poims vs (4.0 ± 1.1) points,during exercise:(3.7 ± 0.9) points vs (4.6 ± 1.4) points] (P ＜ 0.05).Incidence of agitation and use rate of tramadol in group A were significantly lower than those in group B [17.1％ (6/35) vs 37.1％ (13/35),17.1％ (6/35) vs 37.1％ (13/35)] (P ＜ 0.05).Conclusion Compared to 0.5 pg/kg,sufentanil 1.0 μg/kg used for general anesthesia before skin incision in open gastrointestinal surgery has more stable perioperative hemodynamics and better anesthetic effect;it can reduce intraoperative dosage of remifentanil and postoperative risk of hyperalgesia.