الفهرس 
Pharmacology of opioidsOnly 14 pages are availabe for public view
 |  | from | 150 |  |  |
| | | from | 150 | | |
Abstract
This study was designed to evaluate the use of remifentanil in
anesthetic practice for induction and maintenance of anesthesia and
comprised 100 patients with ASA status I and II assigned to undergo
major abdominal surgery. Patients were categorized into two main
categories according to the purpose of the study.
For evaluation of the use of remifentanil during induction group I,
comprised 60 patients, was studied through subgrouping according to
the drug used to facilitate tracheal intubation, succinylcholine, fentanyl
and remifentanil, respectively.
For evaluation of adequacy of maintenance of anesthesia using
remifentanil continuous infusion, recovery profile as regards the ease of
emergence off anesthesia, postanesthetic sedation and postoperative
pain, 40 patients were included in two subgroups the first received a
placebo bolus and a continuous infusion of remifentanil and the second
received fentanyl as a bolus dose and a placebo continuous infusion.
Tracheal intubation using either suxamethonium or remifentanil
was superiorly satisfying in comparison to propofol with a non-significant
difference between suxamethonium and remifentanil that was in favor of
suxamethonium. The anesthetist found intubation excellently easy was
15 (75%), 11 (55%) and 6 (30%), in suxamethonium, remifentanil and
propofol, respectively with a significant difference in favor of remifentanil
in comparison to propofol.
Blood pressure measures and heart rate were significantly
(P<0.05) decreased in patients received either fentanyl or remifentanil
compared to their preoperative measures, with the decrease being more
pronounced in-those received remifentanil. Moreover, post-induction
measures were significantly (P<0.05) decreased remifentanil group
compared to that recorded in fentanyl group. However, these changes
in blood pressure were not maintained and the mean of the
Summary 139
measurements recorded minutely for 5-min showed a non-significant
(P>0.05) difference compared to preoperative measures.
Remifentanil infusion provided more manifest hemodynamic
stability throughout the duration of surgery manifested by non-significant
(P>0.05) changes of blood pressure or heart rate in comparison to
changes occurred in patients maintained on placebo infusion.
Blood glucose and serum cortisol levels estimated 5 min after
skin incision showed a significant (P<0.05) increase compared to the
preoperative estimates in both groups with a significant (P<0.05)
increase in placebo compared to remifentanil infusion group, however
throughout the operative duration, intraoperative blood glucose level
showed increase compared to the preoperative estimates in both
groups that was significant (P<0.05) in placebo but non-significant
(P>0.05) in remifentanil infusion group. Comparison of postoperative
versus intraoperative blood glucose levels showed a significant
(P<0.05) decrease in placebo group, whereas was non-significant
(P>0.05) in remifentanil infusion group.
Patients received remifentanil infusion showed a significantly
(X2=5.5, P<0.05) earlier recovery rate compared to those received
placebo infusion, whereas 8 patients in group IIa, while 4 patients in
group IIb achieved full recovery 12 minutes after discontinuation of
infusion, another 12 and 10 patients in both groups respectively
achieved full recovery after 15 minutes and only 6 patients in group IIb
achieved full recovery after 30 minutes, while no patients in group IIa
remained till 30 minutes without achieving full recovery.
Maintenance of anesthesia depending on remifentanil infusion
did not provide adequate postoperative analgesia as manifested by the
non-significant (P>0.05) increase reported between patients maintained
on remifentanil infusion and those maintained on inhalational
anesthesia as regards total score and differential scores at each time of
recording, number of patients requesting rescue analgesia, and the
total dose of pethidine requested.