Roles of Epidural Anesthesia and Remifentanil in Intraoperative Analgesia

Abstract

  Surgical stress is well known to activate the neuroendocrine response, blood coagulability and metabolism and to reduce the immune response, thereby causing intraoperative hyperglycemia or endotherial impairment and postoperative surgical site infection. Intraoperative analgesia plays an important role in attenuating these unfavorable responses. In particular epidural anesthesia and an intravenous infusion of remifentanil are increasingly used in intraoperative analgesia due to their strong analgesic actions, which prevent activation of neuroendocrine and metabolic response systems and reduction in the immune response system, thereby providing better postoperative prognosis. Analgesia provided by the infusion of remifentanil is considered to be of a quality on par with that by epidural analgesia to maintain intraoperative homeostasis on neuroendocrine and metabolic responses under certain conditions.