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Inflammation affects sufentanil consumption in ulcerative colitis

Published online by Cambridge University Press:  01 March 2008

M. Fleyfel ,
C. Dusson ,
M.-L. Ousmane ,
A. Guidat ,
J. F. Colombel ,
L. Gambiez  and
B. Vallet
M. Fleyfel*
Affiliation:
CHRU de Lille, Federation of Anesthesiology and Intensive Care Medecine, Lille Cedex, France
C. Dusson
Affiliation:
CHRU de Lille, Federation of Anesthesiology and Intensive Care Medecine, Lille Cedex, France
M.-L. Ousmane
Affiliation:
CHRU de Lille, Anesthésie Réanimation Huriez, Lille Cedex, France
A. Guidat
Affiliation:
CHRU de Lille, Federation of Anesthesiology and Intensive Care Medecine, Lille Cedex, France
J. F. Colombel
Affiliation:
CHRU de Lille, Department of Gastro-Enterology, Lille Cedex, France
L. Gambiez
Affiliation:
CHRU de Lille, Department of Gastro-Enterology, Lille Cedex, France
B. Vallet
Affiliation:
CHRU de Lille, Federation of Anesthesiology and Intensive Care Medecine, Lille Cedex, France
*
Correspondence to: Maher Fleyfel, Federation of Anesthesiology and Intensive Care Medecine, CHRU de Lille, Lille Cedex, France. E-mail: m-fleyfel@chrulille.fr; Tel: +33 3 2044 5196; Fax: +33 3 2044 6365
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Summary

Background

Previous studies have demonstrated an increased perioperative opioid requirement during inflammatory disease. To evaluate the influence of the inflammatory process, we studied in the same patient the sufentanil requirement during procedures that occur during two distinct phases of ulcerative colitis with different inflammatory profiles: (1) left colectomy for major colitis unresponsive to medical treatment during acute inflammation and (2) coloprotectomy with ileoanal anastomosis, three months after recovery of the acute inflammatory episode.

Methods

Sixteen patients with clinical and histological evidence of ulcerative colitis scheduled for colectomy with ileoanal anastomosis were included. For each surgical procedure, anaesthesia was induced with sufentanil 0.5 μg kg−1 and propofol 2 mg kg−1. Patients were ventilated with 50% nitrous oxide and oxygen, and tidal volume was adjusted to keep end-tidal CO2 at 30 mmHg. Anaesthesia was maintained with end-tidal isoflurane at 0.5%. Analgesia was achieved with continuous infusion of sufentanil at 0.3 μg kg−1 h−1. Additional boluses of sufentanil and increases in infusion rates were used when haemodynamic variables increased to more than 20% of preoperative values. Sufentanil consumption during surgery was analysed by Wilcoxon signed rank sum test. P < 0.05 was considered significant.

Results

Total intra-operative sufentanil requirement was significantly larger during colectomy performed for acute inflammatory colitis than during ileoanal anastomosis performed after the inflammatory process (1.24 ± 0.48 μg kg−1 h−1 vs. 0.62 ± 0.3 μg kg−1 h−1; P < 0.05).

Conclusion

For the same patient, inflammatory status influences opioid requirements during surgery for ulcerative colitis.

Keywords

PAIN ACUTE AND POSTOPERATIVEANALGESICS OPIOIDINFLAMMATORY BOWEL DISEASESURGICAL PROCEDURES, abdominal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 3 , March 2008 , pp. 188 - 192
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

[1.]Mayer, EA, Gebhart, GF. Basic and clinical aspect of visceral hyperalgesia. Gastroenrerology 1994; 107: 271–293.Google Scholar
[2.]Screider, S, Raedler, A, Stanon, WF, Mc Dermott, RP. The role of the mucosal immune system in inflammatory bowel disease. Gastroenterol Clin North Am 1992; 21: 451–502.Google Scholar
[3.]Dray, A. Inflammatory mediators in pain. Br J Anaesth 1995; 75: 125–131.Google Scholar
[4.]Gebhart, GF. Peripheral contributions to visceral hyperalgesia. Can J Gastroenterol 1999; 13 (Suppl A): 37A–41A.CrossRefGoogle ScholarPubMed
[5.]Weeke, B, Jaenum, S. Serum concentration of 19 serum proteins in Crohn’s disease and ulcerative colitis. Gut 1971; 12: 297–302.CrossRefGoogle Scholar
[6.]Van der Veer, G, Burm, AG, Vletter, AA, Bovill, JG. Influence of Crohn’s disease on the pharmacokinetics and pharmacodynamics of alfentanil. Br J Anaesth 1993; 71: 827–834.CrossRefGoogle Scholar
[7.]Guidat, A, Fleyfel, M, Vallet, B et al. . Inflammation increases sufentanil requirements during surgery for inflammatory bowel diseases. Eur J Anaesthesiol 2003; 20: 957–962.CrossRefGoogle ScholarPubMed
[8.]Edwards, RC, Truelove, SC. The course and prognosis of ulcerative colitis: part I and II. Short term and long term prognosis. Gut 1963; 4: 299–308.Google Scholar
[9.]Dahaba, AA. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg 2005; 101: 765–773.CrossRefGoogle ScholarPubMed
[10.]Dierckens, E, Fleyfel, M, Robin, E et al. . Is entropy a monitor for the guidance of intraoperative analgesia? Ann Fr Anesth Réanim 2007; 26: 113–118.Google Scholar
[11.]Bertz, RJ, Granneman, GR. Use of in vitro and in vivo data to estimate the likelihood of metabolic pharmacokinetic interaction. Clin Pharmacokinet 1997; 32: 210–258.CrossRefGoogle Scholar
[12.]Olstad, OA, Skjelbred, P. Comparison of the analgesic effect of a corticosteroid and paracetamol in patients with pain after oral surgery. Br J Clin Pharmacol 1986; 22: 437–442.CrossRefGoogle ScholarPubMed
[13.]Skjelbred, P, Lokken, P. Post-operative pain and inflammatory reaction reduced by injection of a corticosteroid. A controlled trial in bilateral oral surgery. Eur J Clin Pharmacol 1982; 21: 391–396.Google Scholar
[14.]Bueno, L, Fioramonti, J. Effects of inflammatory mediators on gut sensitivity. Can J Gastroenterol 1999; 13: 42A–46A.CrossRefGoogle ScholarPubMed
[15.]Gebhart, GF. Visceral nociception: consequences, modulation and the future. Eur J Anaesth 1995; 12 (Suppl 10): 24–27.Google Scholar
[16.]Giamberardino, MA, Vecchiet, L. Visceral pain, referred hyperalgesia and outcome: new concepts. Eur J Anaesthesiol 1995; 12: 61–66.Google Scholar
[17.]Rao, SS, Read, NW, Davison, PA et al. . Anorectal sensitivity and responses to rectal distension in patients with ulcerative colitis. Gastroenterology 1987; 93: 1270–1275.CrossRefGoogle Scholar
[18.]Galeazzi, F, Luca, MG, Lanaro, D et al. . Esophageal hyperalgesia in patients with ulcerative colitis: role of experimental stress. Am J Gastroenterol 2001; 96: 2590–2595.Google Scholar
[19.]Verne, GN, Robinson, ME, Price, DD. Hypersensitivity to visceral and cutaneous pain in the irritable bowel syndrome. Pain 2001; 93: 7–14.CrossRefGoogle ScholarPubMed