Inflammatory Effect Comparison Between Fentanyl and Remifentanil in Mastectomy Under General Anesthesia
Status:
Completed
Trial end date:
2021-04-30
Target enrollment:
Participant gender:
Summary
Mastectomy triggers stress and inflammation responses due to tissue trauma. Surgical stress
will increase levels of hormones (adrenocorticotropic hormone, cortisol, antidiuretic
hormone, epinephrine, norepinephrine, and dopamine) and inflammatory cytokines (Tumor
Necrotic Factor-α, interleukin-1, interleukin-2, and interleukin-6) in the body. This causes
insulin resistance, gluconeogenesis, and glycolysis, and impaired insulin secretion, which
results in hyperglycemia due to intraoperative stress. Intraoperative hyperglycemia increases
postoperative complications and mortality. Inhibition of hyperglycemia due to operative
stress and stress hormones with good anesthetic management in improving patient outcomes.
The choice of opioid type plays an important role in suppressing the perioperative stress and
inflammatory response. Opioids are an alternative, besides the use of regional anesthetic
techniques which have been proven to suppress the perioperative stress response. Fentanyl is
one of the phenylpiperidine synthetic opioids. Large doses of fentanyl can reduce stress
responses but also increase side effects, such as hemodynamic instability and decrease T-cell
function.
Remifentanil provides unique pharmacokinetic benefits through nonspecific esterase enzyme
metabolism, so it has a very fast onset and half-life. In addition, remifentanil also
provides benefits in reducing the production of interleukin 6 cytokines (IL-6) and tumor
necrosis factor α (TNF-α) and inhibits neutrophil migration through the endothelial layer.
The stress response to stress and inflammation is directly proportional to the dose of
remifentanil given. It is reported that remifentanil can suppress cortisol response according
to increasing dose.
Winterhalter et al. and Lee et al. reported that remifentanil is better at suppressing the
stress response than fentanyl. On the other hand, Bell et al. showed no difference in
cortisol and hemodynamic levels between the two groups.
The goal of this study is to see if remifentanil provides less increase in serum epinephrine
level, norepinephrine level, platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio
(LMR), and blood glucose level at one-hour and 24-hours postoperative in patients undergoing
mastectomy surgery under general anesthesia.