Neuroendocrine stress response and hyperglycemia in children undergoing laparoscopic surgery: a comparative study between remifentanil infusion and fentanyl boluses during sevoflurane-based anesthesia

Objective The aim of the study was to determine the effect of remifentanil (REM) infusion versus fentanyl (FEN) boluses during sevoflurane-based anesthesia on the frequency and the severity of stress hyperglycemia in children undergoing laparoscopic surgery. Patients and methods The study included 64 children randomly allocated into the REM group, receiving REM infusion (0.05-0.5 μg/kg/min), and the FEN group, receiving FEN boluses of 1 - 2 μg/kg. All patients were maintained by sevoflurane (1-2%) inhalation. Six blood samples were taken for the estimation of random blood glucose (RBG), serum glucagon and insulin, and plasma adrenaline. Hyperglycemia was considered if RBG was more than 140 mg/dl, and was treated with insulin if RBG was more than 200 mg/dl. The frequency and the extent of hyperglycemia were determined in both groups. Results In the FEN group, RBG levels were elevated from the start of surgery till second postoperative day with a significant difference compared with baseline levels. Eight patients had RBG less than 140 mg/dl, and 13 patients had temporary and 11 had persistent hyperglycemia, and four of them required insulin therapy. There were significant elevations in the serum glucagon and plasma adrenaline with a significant decrease in the serum insulin. In the REM group, meanRBG levels were significantly elevated from the time of maximal surgical stress till second postoperative day in comparison with baseline levels, but were significantly lower compared with the FEN group. Fourteen patients had RBG less than 140 mg/dl, 12 patients had temporary and six had persistent hyperglycemia, and three of them required insulin therapy with a significantly lower frequency of both temporary and persistent hyperglycemia and a nonsignificantly lower number of patients received insulin therapy in the REM group compared with the FEN group. There were significantly lower plasma adrenaline and glucagon levels, with a nonsignificantly lower serum insulin level in the REM group compared with the FEN group. Conclusion REM/sevoflurane anesthesia attenuated the neuroendocrine stress response during laparoscopic surgery and reduced the frequency and the extent of intraoperative and postoperative hyperglycemia, with sparing need for insulin therapy.