Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil / 대한마취과학회지
Korean Journal of Anesthesiology
; : 44-51, 2014.
Article
em En
| WPRIM
| ID: wpr-52960
Biblioteca responsável:
WPRO
ABSTRACT
BACKGROUND: High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS. METHODS: Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 microg/kg/min; group H at 0.3 microg/kg/min; and group HK at 0.3 microg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 microg/kg/min ketamine until skin closure. RESULTS: PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups. CONCLUSIONS: OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.
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Assunto principal:
Dor Pós-Operatória
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Estremecimento
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Pele
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Procedimentos Cirúrgicos em Ginecologia
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Membrana Timpânica
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Analgesia Controlada pelo Paciente
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N-Metilaspartato
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Limiar da Dor
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Hiperalgesia
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Anestesia
Limite:
Female
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Humans
Idioma:
En
Revista:
Korean Journal of Anesthesiology
Ano de publicação:
2014
Tipo de documento:
Article