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Effect of different doses of remifentanil on stress response during laparoscopic cholecystectomy

Laura Levantesi, MD, Flaminio Sessa, MD, Elisabetta Congedo, MD, Francesco Di Nardo, MD, Marco Oggiano, MD, Gennaro Canistro, MD, Rossella Sicuranza, MD, Luca Nicosia, MD, Germano De Cosmo, PhD


Objectives: An adequate perioperative analgesia reduces neuroendocrine stress response and postoperative complications. Opioids are the most effective parenteral drugs to control pain and stress response.

Design: This is a prospective randomized double-blinded controlled study.

Setting: Institutional tertiary level.

Patients, participants: Fifty patients underwent general anesthesia with desflurane for laparoscopic cholecystectomy.

Main outcome measures: To compare two different doses of remifentanil (0.15 mcg/kg/min or 0.3 mcg/kg/min) in reducing markers of stress. Perioperative stress was assessed through the dosage of adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), and prolactin (PRL). Three venous blood samples were collected from patients: before transferring the patient to the operating room (Time 0), at the trocar insertion (Time 1), and 1 hour after the end of the surgery (Time 2).

Results: Hemodynamic parameters showed no differences between the two groups. The authors observed an increase of GH and PRL in both groups at trocar insertion (Time 1) (p = 0.473 and 0.754, respectively). ACTH and cortisol showed a decrease at Time 1 and an increase after surgery (p = 0.586). The modification of stress parameters levels showed no significant differences between the two groups.

Conclusions: The results of our study showed that a lower dose of remifentanil is equally effective in controlling stress hormones during laparoscopic cholecystectomy.


remifentanil, cortisol, prolactin, growth hormone, adrenocorticotropic hormone, stress, general anesthesia

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