Αναισθησία με αλφεντανύλη και διεγχειρητικό stress: Κλινικοεργαστηριακή μελέτη
An operation is a harmful stimulus and the organism reacts to that by the release of a series of stress-hormones and the institution of hyperdynamic circulation. The aim of all these, is to mobilize all the available energy resources in order to facilitate its escape from the threatening condition which the organism faces. This reaction however, could be dangerous when the myocardium O₂ demands, are greater than supply with resultant ischemia. This is why it is advocated that the operation-induced stress response should be suppressed. The aim of our study was to evaluate the action of Alfentanil (AF) on the operation-induced stress-response, as well as quick recovery from anaesthesia with adequate respiration in high doses (bolus and i.v. infusion) for operations of moderate duration and significance, in routine anaesthesia practice. AF was administered as the sole anaesthetic agent for induction of anaesthesia in bolus doses of 121 ± 19 Mg Kg⁻¹ (mean dose ± S.D.) and in i.v. infusion with a rate of 1-3 μg Kg⁻¹ min⁻¹ for maintance of anaesthesia. We studied 40 women of good health status, ASA l-ll who underwent mastectomy operations. They were randomly divided in two groups: Group A (study group) received AF and Group Β (control group) received thiopental for induction and halothane for maintance of anaesthesia. The patients of these groups were comparable concerning their physical status, bodyweight, age and the duration of operation and anaesthesia. Both groups received Thalamonal 0,03 ml Kg⁻¹ for premedication, Sch to facilitate the tracheal intubation and pancuronium for muscle relaxation and they were ventilated with a mixture of N₂O/O₂ for 3:2 L/min. We compared the influence of AF on systolic (SBP) and diastolic (DBP) blood pressures, heart rate and the plasma levels of Cortisol, glucose and prolactin (PRL) in group A with those of group Β in 6 instances perioperatively and with those of preoperative values (control values). AF did not permit the occurrence of considerable changes in SBP, DBP and HR during whole duration of anaesthesia including the period of laryngoscopy and intubation. In AF group the plasma levels of glucose and cortisol increased (in comparison with the control levels) at 10' and 30' min respectively after the initiation of the operation. The plasma levels of PRL decreased in the end of the operation. The increase of Cortisol and glucose levels were milder in the AF group (group A) than in the control group (group B) and of no clinical significance concerning that their plasma levels were within the normal range levels. The recovery from anaesthesia and the return of automatic respiration in 10 ± 9 min were significantly quicker in the AF group whereas the most frequent adverse effects were nausea and vomiting. We can conclude that AF in the manner and dose that were used, suppressed the laryngoscopy and intubation stress-response and the excessive operation-induced stress response without abolishing it. So AF can protect the organism from an intense stress response, offers cardiovascular stability, quick recovery from anaesthesia with adequate respiration and prolonged postoperative analgesia without any serious adverse effects.
Αναισθησία, Αλφεντανύλη, Anaesthesia, Alfentanil (AF), Ιατρική και Επιστήμες Υγείας, Κλινική Ιατρική, Medical and Health Sciences, Clinical Medicine
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Aristotle University Of Thessaloniki (AUTH)