The effect of different anaesthetic technics on stress response to the surgery [Farkli anestezi yöntemlerinin cerrahi stres yanit üzerindeki etkisi]

Abstract

Aim: This study compared the hemodynamic, metabolic and endocrine including leptin responses to surgery with total intravenous anesthesia (TIVA) with propofol-alfentanil or propofol-remifentanil and sevoflurane anesthesia. Materials ve Methods: Fortyfive ASA I-II, patients scheduled to undergo abdominal surgery were randomly divided into three groups (N=15). General anaesthesia induction and neuromuscular paralysis were performed in all patients with 1,5 mg kg-1 propofol and 0.1 mg kg-1 vecuronium respectively. In Addition group I patients were given 1 ?g kg-1 fentanyl, group II patients were given 40 ?g kg-1 alfentanil and group III patients were given 1 ?g kg-1 remifentanil. Maintenance anaesthesia was performed in group I with 1.5-3 % sevoflurane and 50 % N 2O/O2 in group II with 100 ?g kg-1 min -1 propofol and 2 ?g kg-1 min-1 alfentanil and after the first hour 1 ?g kg-1 min-1 alfentanil infusion. Third group was administered 100 ?g kg-1 propofol and 0.25 ?g kg-1 min-1 remifentanil infusion. Hemodynamic changes were recorded. Plasma cortisol, ACTH, prolactin, insulin, glucose and leptin concentration were determined, one hour post-incision and 24th hours with RIA or IRMA methods as appropriate. Results: Hemodynamic response to intubation and surgical incision was depressed at alfentanil and remifentanil groups (p<0.05). ACTH and cortisol levels were depressed significantly at remifentanil group (p<0.05). Prolactin levels were significantly elevated in all groups (p<0.05). Blood glucose levels were lower in the TIVA groups. Compared to preoperative levels leptin was significantly decreased one hour post intubation and increased at 24 hours postoperatively in all groups. Conclusions: We conclude that in healthy patients undergoing abdominal surgery TIVA with propofol-remifentanil blunts perioperative hemodynamic, metabolic and endocrine responses when compared to sevoflurane anesthesia. Leptin concentrations first decrease than increase during the first 24 hours of surgery.