The Effect of Remifentanil– Propofol Compared with Fentanyl– Propofol on Urine Output in Patients Undergoing Lumbar Posterior Spinal Fusion
AbstractBackground: Remifentanil is a narcotic drug used in anaesthesia for establishment of hemodynamic stability. The purpose of this study was to compare the effects of remifentanil and fentanyl on urine excretion.Methods: In a randomized clinical trial, 60 patients, who were candidates for elective surgery for lumbar posterior spinal fusion, were divided randomly into two groups of 30 as remifentanil – propofol (R) and fentanyl- propofol (F). Maintenance of anaesthesia drugs in group R included 100 mcg/kg/min propofol and 0.5- 0.25 mcg/kg/min remifentanil. It included 100 mcg/kg/min propofol and 5- 0.5 mcg/kg/min fentanyl in group F. Vital signs and urine output were recorded every half an hour.Results: The mean age of patients was 49.5± 12.7 years. Urine output in group R showed significantly greater reduction than in group F (p< 0.001). Increase of urine output was seen in both groups over the time.Conclusion: Urine output in patients undergoing lumbar posterior spinal fusion who received remifentanil was less compared to the fentanyl group.
Mercatello A. [Changes in renal function induced by anesthesia]. Ann Fr Anesth Reanim. 1990; 9(6):507-24.
Papper S, Papper EM. The effects of preanesthetic, anesthetic, and postoperative drugs on renal function. Clin Pharmacol Ther. 1964; 5(2):205-15.
Everett GB, Allen GD, Kennedy WF Jr, Gerbershagen HU, Cutler RE, Sawyer TK. Renal hemodynamic effects of general anesthesia in outpatients. Anesth Analg. 1973; 52(3):470-9.
Kawai M, Nakata J, Kawaguchi M, Takahashi T, Hara M, Yamaguchi S, et al. [Comparison of urinary output during general anesthesia]. Masui. 2010; 59(2):179-82.
Amano J, Suzuki A, Sunamori M. Antidiuretic hormone and cardiovascular responses during and after coronary artery bypass surgery. Thorac Cardiovasc Surg. 1993; 41(5):297-300.
Cregg N, Mannion D, Casey W. Oliguria during corrective spinal surgery for idiopathic scoliosis: The role of antidiuretic hormone. Paediatr Anaesth. 1999; 9(6):505-14.
Pesonen A, Leppaluoto J, Ruskoaho H. Mechanism of opioid-induced atrial natriuretic peptide release in conscious rats. J Pharmacol Exp Ther. 1990; 254(2):690-5.
Salas SP, Roblero JS, López LF, Tachibana S, Huidobro-Toro JP. [N-methyl-Tyr1,N-methyl-Arg7-D-Leu8]-dynorphin-A-(1-8)ethylamide, a stable dynorphin analog, produces diuresis by kappa-opiate receptor activation in the rat. J Pharmacol Exp Ther. 1992; 262(3):979-86.
Aghadoost D, Fazel MR, Fakharian E. Comparing remifentanil versus propofol effect on pain and homodynamic change of patients undergoingphacoemulsification with topical anesthesia. Iran Red Crescent Med J. 2013; 15(5):424-7.
Kabon B, Kugener A, Gruenberger T, Niedermayr M, Fleischmann E, Freissmuth M, et al. Effects of continuous remifentanil administration on intra-operative subcutaneous tissue oxygen tension. Anaesthesia. 2007; 62(11):1101-9.
Komatsu R, Turan AM, Orhan-Sungur M, McGuire J, Radke OC, Apfel CC. Remifentanil for general anaesthesia: a systematic review. Anaesthesia. 2007; 62(12):1266-80.
Rosow CE. An overview of remifentanil. Anesthesia and Analgesia. 1999; 89(4 Suppl):S1-3.
Servin F. Remifentanil: when and how to use it. Eur J Anaesthesiol Suppl. 1997; 15:41-4.
Kawano H, Manabe S, Matsumoto T, Hamaguchi E, Kinoshita M, Tadaet F, et al. Comparison of intraoperative blood loss during spinal surgery using either remifentanil or fentanyl as an adjuvant to general anesthesia. BMC Anesthesiol. 2013; 13(1):46.
Yago Y, Tajiri O, Ito H, Kanazawa M, Tateda T. [Effect of remifentanil on urine output during gynecological laparoscopic surgery]. Masui. 2009; 58(5):613-5.
Ko JS, Gwak MS, Choi SJ, Kim GS, Kim JA, Yang M, et al. The effects of desflurane and propofol-remifentanil on postoperative hepatic and renal functions after right hepatectomy in liver donors. Liver Transpl. 2008; 14(8):1150-8.
Onaka M, Yamamoto H. [Remifentanil may be beneficial to urinary output under epidural-based general anesthesia]. Masui. 2010; 59(11):1391-5.
Ishikawa K, Sakai A, Nagata H, Wakimoto M, Suzuki T, Oouchi S, et al. [Remifentanil increases urine output in patients undergoing laparoscopic colectomy]. Masui. 2012; 61(5):526-30.
Stainsby D, MacLennan S, Hamilton PJ. Management of massive blood loss: a template guideline. Br J Anaesth. 2000; 85(3):487-91.
Stafford-Smith M. Perioperative renal dysfunction: Implications and strategies for protection. In: Newman MF, ed. Perioperative Organ Protection, Baltimore: Lippincott Williams & Wilkins; 2003:89-124.
Badr KF, Ichikawa I. Prerenal failure: A deleterious shift from renal compensation to decompensation. N Engl J Med. 1988; 319(10):623-9.
Alpert RA, Roizen MF, Hamilton WK, Stoney RJ, Ehrenfeld WK, Poler SM, et al. Intraoperative urinary output does not predict postoperative renal function in patients undergoing abdominal aortic revascularization. Surgery. 1984; 95(6):707-11.
Shin B, Isenhower NN, McAslan TC, Mackenzie CF, Helrich M. Early recognition of renal insufficiency in post-anesthetic trauma victims. Anesthesiology. 1979; 50(3):262-5.
Knos GB, Berry AJ, Isaacson IJ, Weitz FI. Intraoperative urinary output and postoperative blood urea nitrogen and creatinine levels in patients undergoing aortic reconstructive surgery. J Clin Anesth. 1989; 1(3):181-5.
Kuipers PW, Kamphuis ET, van Venrooij GE, van Roy JP, Ionescu TI, Knape JT, et al: Intrathecal opioids and lower urinary tract function: A urodynamic evaluation. Anesthesiology. 2004; 100(6):1497-503.
Malinovsky JM, Le Normand L, Lepage JY, Malinge M, Cozian A, Pinaud M, et al. The urodynamic effects of intravenous opioids and ketoprofen in humans. Anesth Analg. 1998; 87(2):456-61.
Terashi T, Takehara A, Kuniyoshi T, Matsunaga A, Kawasaki K, Kanmura Y. Remifentanil temporarily improves renal function in adult patients with chronic kidney disease undergoing orthopedic surgery. J Anesth. 2013; 27(3):340-5.