Volume 30, Issue 1, 2021
DOI: 10.24205/03276716.2020.2028
Comparison of Effects of Propofol or Sevoflurane Combined with Remifentanil on Stress Response, Inflammatory Factors and Cerebral Oxygen Metabolism in Patients Undergoing Radical Esophagectomy
Abstract
Objectives: Clinical studies have shown that reducing the stress response and catabolism
during the perioperative period and strengthening nutritional support during the
perioperative period can improve the surgical effect and promote postoperative
recovery. However, there are few studies on the effects of general anesthesia
maintenance drugs on the catabolism and nutritional status of surgical patients. Based on
the above background, the purpose of this article is to compare the effects of propofol or
sevoflurane combined with remifentanil on the stress response, inflammatory factors and
cerebral oxygen metabolism in patients undergoing radical resection of esophageal
cancer.
Methods: 120 patients who underwent radical esophageal cancer surgery in our hospital
from February 2018 to August 2019 were randomly divided into group A and group B,
with 60 patients in each group. Patients in group A were anesthetized with propofol
combined with remifentanil, group B were anesthetized with sevoflurane combined with
remifentanil. Before and after induction of anesthesia (T0), at the beginning of surgery
(T1), and 12 hours after surgery (T2), the differences in peripheral blood stress response
indexes, inflammatory factors, and cerebral oxygen metabolism index were measured.
Results: (1) Compared with T0 stage, the stress response indicators of patients in T1 and
T2 stages-cortisol (COR) and norepinephrine (NE) were significantly up-regulated, and the
inflammatory factors IL-8, IL-6, TNF- α was also significantly up-regulated (P<0.05), while
the cerebral oxygen metabolism index arterial partial pressure of carbon dioxide (PaCO2),
internal jugular venous partial pressure of carbon dioxide (PjvCO2), internal jugular
venous blood oxygen partial pressure (PjvO2), internal cervical Venous oxygen saturation
(SjvO2) was significantly reduced. (2) After comparing group, A and group B patients using
different anesthesia methods, comparing the stress response index, inflammatory factor
index and cerebral oxygen metabolism index, it was found that the stress response index
and inflammatory factor index of group A were higher than those of group B. Patients in
group B (P<0.05), while the cerebral oxygen metabolism index of patients in group A was
significantly lower than that of patients in group B (P<0.05).
Conclusions: Compared with sevoflurane combined with remifentanil anesthesia,
propofol combined with remifentanil anesthesia is more beneficial to the stress response,
reduction of inflammatory factors and improvement of cerebral oxygen metabolism in
patients with radical esophageal cancer
Keywords
Stress response; Inflammatory factors; Cerebral oxygen metabolism; Radical resection of esophageal cancer