To compare the effects of remifentanil with alfentanil as a part of total intravenous anesthesia (TIVA) on plasma concentrations of cortisol, insulin, and glucose, and hemodynamic responses in patients undergoing abdominal hysterectomy.

Randomized, double-blind study.

University hospital.

24 ASA physical status I female patients scheduled for abdominal hysterectomy.

Premedicated patients were randomly allocated to receive either remifentanil-propofol (Group R) or alfentanil-propofol (Group A). The loading dose of the study drug was administered over 60 seconds (remifentanil l μg kg^−l or alfentanil 10 μg kg^−l) followed by a continuous infusion (remifentanil 0.2 μg kg^−l min^−l or alfentanil 0.5 μg kg^−l min^−l). In both groups, propofol was administered until loss of consciousness and maintained with a propofol infusion rate of 100 μg kg^−l min^−l. After induction of anesthesia, all patients were manually ventilated by mask with O₂-air mixture for 20 minutes. Then rocuronium 0.6 mg kg^−l was given for tracheal intubation.

Mean arterial pressure (MAP) and heart rate (HR) were recorded. Plasma concentrations of cortisol, insulin, and glucose were measured during anesthesia and in the recovery room.

In Group R, MAP and HR were lower after tracheal intubation and skin incision than in Group A (p < 0.05). Plasma cortisol concentrations decreased from baseline values at 20 minutes after induction, after tracheal intubation, and skin incision in Group R (p < 0.001). Plasma concentrations of cortisol and glucose increased from baseline values at 30 minutes after skin incision and continued to increase in both groups (p = 0.001). Plasma concentrations of cortisol, insulin, and glucose did not differ between groups at all sampling times.

Remifentanil provided better hemodynamic stability than alfentanil during anesthesia and surgery. However, both remifentanil and alfentanil had similar effects on the stress endocrine response to abdominal hysterectomy.