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

open access

Page views 2432
Article views/downloads 1029
Get Citation

Connect on Social Media

Connect on Social Media

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.

Abstract

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.

Article available in PDF format

View PDF Download PDF file

References

  1. Lewandowski KC, Malicka K, Dąbrowska K, et al. Addison's disease concomitant with corticotropin deficiency and pituitary CRH resistance - a case report. Endokrynol Pol. 2017; 68(4): 468–471.
  2. Żukowski Ł, Myśliwiec J, Górska M. Diagnostics of hypercortisolism - comparison between the clinical usefulness of salivary and serum cortisol measurements. Endokrynol Pol. 2013; 64(4): 263–267.
  3. Gaszyński T, Wieczorek A. A comparison of BIS recordings during propofol-based total intravenous anaesthesia and sevoflurane-based inhalational anaesthesia in obese patients. Anaesthesiol Intensive Ther. 2016; 48(4): 239–247.
  4. Wang J, Ma H, Zhou H, et al. Effect of preoperative intravenous oxycodone administration on sufentanil consumption after retroperitoneal laparoscopic nephrectomy. Anaesthesiol Intensive Ther. 2016; 48(5): 300–304.
  5. Zielińska M, Bartkowska-Śniatkowska A, Mierzewska-Szmidt M, et al. The consensus statement of the Paediatric Section of the Polish Society of Anaesthesiology and Intensive Therapy on general anaesthesia in children over 3 years of age. Part I - general guidelines. Anaesthesiol Intensive Ther. 2016; 48(2): 71–78.
  6. Hewitt PM, Ip SM, Kwok SP, et al. Laparoscopic-assisted vs. open surgery for colorectal cancer: comparative study of immune effects. Dis Colon Rectum. 1998; 41(7): 901–909.
  7. Marana E, Scambia G, Maussier ML, et al. Neuroendocrine stress response in patients undergoing benign ovarian cyst surgery by laparoscopy, minilaparotomy, and laparotomy. J Am Assoc Gynecol Laparosc. 2003; 10(2): 159–165.
  8. Whelan RL, Franklin M, Holubar SD, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc. 2003; 17(6): 972–978.
  9. Muzii L, Marana R, Marana E, et al. Evaluation of stress-related hormones after surgery by laparoscopy or laparotomy. J Am Assoc Gynecol Laparosc. 1996; 3(2): 229–234.
  10. Luo K, Li JS, Li LT, et al. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol. 2003; 9(4): 847–850.
  11. Adams HA, Schmitz CS, Baltes-Götz B. [Endocrine stress reaction, hemodynamics and recovery in total intravenous and inhalation anesthesia. Propofol versus isoflurane]. Anaesthesist. 1994; 43(11): 730–737.
  12. Castillo V, Navas E, Naranjo R, et al. [Changes in the concentrations of catecholamines and cortisol in balanced anesthesia and total intravenous anesthesia]. Rev Esp Anestesiol Reanim. 1997; 44(2): 52–55.
  13. Marana E, Annetta MG, Meo F, et al. Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery. Can J Anaesth. 2003; 50(4): 348–354.
  14. Nishiyama T, Yamashita K, Yokoyama T. Stress hormone changes in general anesthesia of long duration: isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia. J Clin Anesth. 2005; 17(8): 586–591.
  15. Misiołek H, Wojcieszek E, Dyaczyńska-Herman A. Comparison of influence of thiopentone, propofol and midazolam on blood serum concentration of noradrenaline and cortisol in patients undergoing non-toxic struma operation. Med Sci Monit. 2000; 6(2): 319–324.
  16. Satani M, Hamada T, Nakada K, et al. [Comparison of total intravenous anesthesia and inhalation anesthesia regarding hormonal responses during lung lobectomy]. Masui. 2005; 54(10): 1109–1115.
  17. Pflug AE, Halter JB. Effect of spinal anesthesia on adrenergic tone and the neuroendocrine responses to surgical stress in humans. Anesthesiology. 1981; 55(2): 120–126.
  18. Akerstedt T, Gillberg M, Hjemdahl P, et al. Comparison of urinary and plasma catecholamine responses to mental stress. Acta Physiol Scand. 1983; 117(1): 19–26.
  19. Orgacka H, Ryszka F, Zych F. Wpływ różnych czynników na poziom katecholamin w ustroju. Post Higieny Med Dosw. 1983; 37: 483–504.
  20. Jörgensen LS, Bönlökke L, Christensen NJ. Plasma adrenaline and noradrenaline during mental stress and isometric exercise in man. The role of arterial sampling. Scand J Clin Lab Invest. 1985; 45(5): 447–452.
  21. Rasmus A, Gaszyński W. Fizjologiczne podstawy odpowiedzi ustroju na stres operacyjny. Anest Inten Ter. 1993; 25: 253–261.
  22. Graziola E, Elena G, Gobbo M, et al. [Stress, hemodynamic and immunological responses to inhaled and intravenous anesthetic techniques for video-assisted laparoscopic cholecystectomy]. Rev Esp Anestesiol Reanim. 2005; 52(4): 208–216.
  23. Gilliland HE, Armstrong MA, Carabine U, et al. The choice of anesthetic maintenance technique influences the antiinflammatory cytokine response to abdominal surgery. Anesth Analg. 1997; 85(6): 1394–1398.
  24. Kelbel I, Weiss M. Anaesthetics and immune function. Curr Opin Anaesthesiol. 2001; 14(6): 685–691.
  25. El Azab SR, Rosseel PMJ, De Lange JJ, et al. Effect of VIMA with sevoflurane versus TIVA with propofol or midazolam-sufentanil on the cytokine response during CABG surgery. Eur J Anaesthesiol. 2002; 19(4): 276–282.
  26. Kurosawa S, Kato M. Anesthetics, immune cells, and immune responses. J Anesth. 2008; 22(3): 263–277.
  27. Schneemilch CE, Bank U. [Release of pro- and anti-inflammatory cytokines during different anesthesia procedures]. Anaesthesiol Reanim. 2001; 26(1): 4–10.
  28. Kain ZN, Zimolo Z, Heninger G. Leptin and the perioperative neuroendocrinological stress response. J Clin Endocrinol Metab. 1999; 84(7): 2438–2442.
  29. Marana E, Scambia G, Colicci S, et al. Leptin and perioperative neuroendocrine stress response with two different anaesthetic techniques. Acta Anaesthesiol Scand. 2008; 52(4): 541–546.
  30. Karayiannakis AJ, Makri GG, Mantzioka A, et al. Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg. 1997; 84(4): 467–471.
  31. Haque Z, Rahman M, Siddique MA, et al. Metabolic and stress responses of the body to trauma: produced by the laparoscopic and open cholecystectomy. Mymensingh Med J. 2004; 13(1): 48–52.
  32. Barker JP, Vafidis GC, Robinson PN, et al. Plasma catecholamine response to cataract surgery: a comparison between general and local anaesthesia. Anaesthesia. 1991; 46(8): 642–645.
  33. Schwall B, Jakob W, Sessler DI, et al. Less adrenergic activation during cataract surgery with total intravenous than with local anesthesia. Acta Anaesthesiol Scand. 2000; 44(3): 343–347.
  34. Kushikata T, Yoshida H, Kudo M, et al. Plasma orexin A increases at emergence from sevoflurane-fentanyl anesthesia in patients undergoing ophthalmologic surgery. Neurosci Lett. 2010; 482(3): 212–215.
  35. Kushikata T, Yoshida H, Kudo M, et al. Changes in plasma orexin A during propofol-fentanyl anaesthesia in patients undergoing eye surgery. Br J Anaesth. 2010; 104(6): 723–727.
  36. Eroglu A, Solak M, Ozen I, et al. Stress hormones during the wake-up test in scoliosis surgery. J Clin Anesth. 2003; 15(1): 15–18.
  37. Kukkonen JP, Holmqvist T, Ammoun S, et al. Functions of the orexinergic/hypocretinergic system. Am J Physiol Cell Physiol. 2002; 283(6): C1567–C1591.
  38. Dong H, Niu J, Su B, et al. Activation of orexin signal in basal forebrain facilitates the emergence from sevoflurane anesthesia in rat. Neuropeptides. 2009; 43(3): 179–185.
  39. Salmi E, Kaisti KK, Metsähonkala L, et al. Sevoflurane and propofol increase 11C-flumazenil binding to gamma-aminobutyric acidA receptors in humans. Anesth Analg. 2004; 99(5): 1420–6; table of contents.
  40. Alkire MT, Pomfrett CJ, Haier RJ, et al. Functional brain imaging during anesthesia in humans: effects of halothane on global and regional cerebral glucose metabolism. Anesthesiology. 1999; 90(3): 701–709.
  41. Jeong YB, Kim JS, Jeong SM, et al. Comparison of the effects of sevoflurane and propofol anaesthesia on regional cerebral glucose metabolism in humans using positron emission tomography. J Int Med Res. 2006; 34(4): 374–384.
  42. Kurehara K, Horiuchi T, Takahashi M, et al. [Relationship between minimum alveolar concentration and electroencephalographic bispectral index as well as spectral edge frequency 95 during isoflurane/epidural or sevoflurane/epidural anesthesia]. Masui. 2001; 50(5): 512–515.