• Hideki Taniguchi, Toshio Sasaki, Hisae Fujita, Osami Takano, Tsutomu Hayashi, Haruhiko Cho, Takaki Yoshikawa, and Akira Tsuburaya.
• School of Nutrition & Dietetics, Kanagawa University of Human Services, Kanagawa, Japan. hstani@aol.com
• Int J Med Sci. 2013 Jan 1;10(9):1099-107.

ObjectiveWe investigated the effect of the intraoperative use of a high dose remifentanil on insulin resistance and muscle protein catabolism.DesignRandomized controlled study.Patients And InterventionThirty-seven patients undergoing elective gastrectomy were randomly assigned to 2 groups that received remifentanil at infusion rates of 0.1 μg·kg(-1)·min(-1) (Group L) and 0.5 μg·kg(-1)·min(-1) (Group H).Main Outcome MeasuresPrimary efficacy parameters were changes in homeostasis model assessment as an index of insulin resistance (HOMA-IR) and 3-methylhistidine/creatinine (3-MH/Cr). HOMA-IR was used to evaluate insulin resistance, and 3-MH/Cr was used to evaluate the progress of muscle protein catabolism. Intraoperative stress hormones, insulin, and blood glucose were assessed as secondary endpoints.ResultsEighteen patients in Group L and 19 in Group H were examined. HOMA-IR values varied within normal limits in both groups during surgery, exceeding normal limits at 12 h after surgery and being significantly elevated in Group L. There were no significant differences in the 3-MH/Cr values between the 2 groups at any time point. The stress hormones (adrenocorticotropic hormone, cortisol, and adrenaline) were significantly elevated in Group L at 60 min after the start of surgery and at the initiation of skin closure. There were no significant differences in insulin values, but blood glucose was significantly elevated in Group L at 60 min after the start of surgery and at the start of skin closure.ConclusionUse of high-dose remifentanil as intraoperative analgesia during elective gastrectomy reduced postoperative insulin resistance, although it did not reduce postoperative muscle protein catabolism.

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