• K Myre, J Raeder, M Rostrup, T Buanes, and O Stokland.
• Department of Anesthesiology, Ullevål University Hospital, Oslo, Norway. kirsti.myre@ioks.uio.no
• Acta Anaesthesiol Scand. 2003 Mar 1;47(3):267-73.

BackgroundReports on stress responses to laparoscopic surgery have been conflicting. Depth of anesthesia may influence the neuro-hormonal release, including catecholamines. Opioids depress general sympathetic activation in a dose-dependent manner. We investigated the hypothesis that remifentanil would depress the catecholamine response to pneumoperitoneum and laparoscopic surgery differently with a high dose (HD) compared with a low dose (LD).MethodsIn a randomized, prospective study we investigated 18 ASA I-II patients undergoing laparoscopic fundoplication with an intra-abdominal pressure of 12 mmHg. The patients were randomized to receive either a LD (0.13 microg kg-1x min-1) or HD (0.39 microg kg-1 x min-1) of remifentanil with a target-controlled infusion (TCI) technique. Bispectral index of EEG (BIS) was maintained at 40-55 by propofol delivered by a TCI system. Arterial catecholamines were analyzed at different times during the procedure.ResultsNorepinephrine increased equally in both groups during pneumoperitoneum and surgical intervention. Epinephrine stayed low in the HD-group, while increasing during surgery in the LD-group.ConclusionHigh dose of remifentanil depressed the epinephrine response to pneumoperitoneum and surgery, indicating no general activation of the sympathetic nervous system. Neither a LD nor HD of remifentanil depressed the norepinephrine response during pneumoperitoneum. This suggests a centrally independent release of norepinephrine.

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