Effects of propofol combined with remifentanil on hemodynamics and stress response in children undergoing surgery for oral cancers, tonsil and adenoid surgery

Abstract

The anesthetic medication to sedate a child during general anesthesia (GA) for oral cancer, adenoidectomy or tonsillectomy is associated with operative complications such as hemodynamic instability and long postoperative recovery period. The current advancement enables combination of different anesthetic medications to decrease operative or postoperative complications associated with GA. In this study assessed the effects of propofol combined with remifentanil on hemodynamics and stress response in children undergoing oral cancer, tonsil and adenoid surgery. Propofol combined with remifentanil is beneficial to anesthesia for children undergoing oral cancer tonsil and adenoid surgery, manifested as stable hemodynamics, rapid recovery, low inflammatory and stress responses, and mild adverse reactions. A total of 106 eligible children treated from May 2017 to December 2019 were randomly divided into observation and control groups (n=53). Observation group was anesthetized by propofol plus remifentanil, while control group was anesthetized by propofol plus esketamine. Mean arterial pressure (MAP), heart rate (HR), serum C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), epinephrine (E), cortisol (Cor), CD3+, CD4+ helper and CD8+ inhibitory T lymphocytes, and CD4+/CD8+were compared before anesthesia induction (T1), immediately after intubation (T2), at the beginning of operation (T3), at the end of operation (T4) and 5 min after extubation (T5). Time of anesthetic recovery and adverse reactions after extubation were observed. MAP and HR significantly rose at T2 compared with those at T1. After maintenance of anesthesia, MAP and HR were significantly lower in observation group than those in control group. Serum CRP, IL-6 and TNF-α levels rose with time. E and Cor levels rose from T1 to T4 and declined at T5, with significant differences at each time point. CRP, IL-6, TNF-α, E and Cor levels were lower in observation group from T3 to T5. At T4 and T5, CD3+, CD4+levels and CD4+/CD8+ declined, whileCD8+level rose compared with those at other three time points. Time of recovery of autonomous respiration and limbs and duration from anesthetic withdrawal to extubation were significantly shorter in observation group. Observation group had lower incidence rate of dysphoria during recovery.