Vol 69, No 4 (2018)
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Published online: 2018-06-13

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Choosing the optimal method of anaesthesia in anterior resection of the rectum procedures — assessment of the stress reaction based on selected hormonal parameters

Elżbieta Wojarska-Tręda1, Krzysztof Olejnik1, Zoran Stojcev2, Szymon Białka3, Hanna Misiołek3
Pubmed: 29952408
Endokrynol Pol 2018;69(4):403-410.


Introduction: The aim of this study was to compare hormonal stress responses (changes in adrenaline, noradrenaline, and cortisol concentrations) to surgical injury during total intravenous propofol anaesthesia and volatile anaesthesia with sevoflurane in patients subjected to anterior resection of the rectum. Material and methods: The prospective randomised study included 61 patients qualified for anterior resection of the rectum. The subjects were randomised into two groups, based on the type of anaesthesia: 1) Group I (TIVA, n = 31), administered total intravenous propofol anaesthesia, and 2) Group II (VIMA, n = 30), administered volatile induction and maintenance sevoflurane anaesthesia. Serum concentra­tions of adrenaline, noradrenaline, and cortisol were determined prior to surgery, during assessment of abdominal cavity, after resection of the rectum, and 30 min and one day post-surgery. Results: The two groups did not differ significantly in terms of their haemodynamic parameters: heart rate and arterial blood pressure. Compared to individuals subjected to TIVA, patients from the VIMA group presented with significantly higher concentrations of adrenaline during evaluation of the abdominal organs. No significant intergroup differences were found in terms of intra- and postoperative serum concentrations of noradrenaline and cortisol. Conclusions: TIVA and VIMA induce similar hormonal stress responses during anterior resection of the rectum. The increase in serum adrenaline concentration during evaluation of the abdominal organs in the VIMA group implies that the dose of sevoflurane should be escalated at this time point.

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