The Change of the Stress Response for Beating Open Heart Surgery with Remifentanil

Objective To explore the effects of the stress response and hemodynamic changes with Infusion of remifentail-propofol for beating open heart surgeryanesthesia.Methods Twenty patients(ASA I～II)with atrial septal defect or eventricular septal defect were induced with midazolam(0.1mg/kg),propofol(1.5～2 mg/kg),vecuronium(0.12 mg/kg),remifentail(1～2μg/kg).All patients were administered remifentanil 0.05～0.1μg/(kg·min) and propofol 4～8mg/(kg·h)infusion to maintain anesthesia.SBP、DBP、MAP、HR and BIS were recorded before induction,1min after induction,1min、3min、5min after intubation,after incision and sternotomy,before CPB,10min end after CPB,closing chest.Meanwhile,blood samples were obtained before induction(T1),5 min after intubation(T2),immediately after sternotomy(T3),before CPB(T4),15 min after CPB(T5)and 10 min end after CPB(T6)from ten patients of those,observing the stress changing during general anesthesia.Results BP at 1min after induction,5min after intubation and before CPB which compared with before induction were significantly lower(P0.05).there is a significant difference that HR after induction compared with before induction(P0.05).BP and HR had not significant difference at each point after intubation compared with after induction.The maintenance of BIS was satistactory.There were statistically significant differences with ACTH and Cor at 15min after CPB,10min end of CPB compared with before induction(P0.01).Conclusion Infusion of remifentail-propofol for beating open heart surgery anesthesia can offer hemodynamic stability.It is not enough effection to decrease stress response.But this way can reach the demend of fast track anesthesia.The administration of anesthesia should be improved during fast track anesthesia.