Abstract
Purpose
Stress response to surgery is modulated by several factors, including magnitude of the injury type of procedure (e.g., laparoscopy vs laparotomy) and type of anesthesia. Our purpose was to compare intra- and postoperative hormonal changes during isoflurane vs sevoflurane anesthesia, in a clinical model of well defined operative stress (laparoscopic pelvic surgery).
Method
In this prospective randomized clinical study, 20 women requiring laparoscopic pelvic surgery for benign ovarian cysts received either a standard isoflurane plus fentanyl (Group A) or sevoflurane plus fentanyl anesthesia (Group B). Blood samples were collected preoperatively 30 min after the beginning of surgery, at the end of surgery after extubation, and “two and four hours after the end of surgery. Intra- and postoperative plasma levels of norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH) and prolactin (PRL) were measured.
Results
Catecholamine levels and postoperative pain were similar in both groups. Nonetheless, in comparison to Group A, Group B showed a significant decrease of ACTH, cortisol and GH levels (A vs B at the end of surgery: ACTH 160 ± 45 vs 100 ± 40 pg·mL−1; cortisol 45 ± 8 vs 23 ± 7 μg·dL−1; GH 3 ± 2 vs 0.8 ± 0.4 ng·mL−1; P < 0.001 for all), but enhanced PRL levels (A vs B, at 30 min after the beginning of surgery: 139 ± 54 vs 185 ± 22 ng·mL−1; at the end of surgery: 100±27 vs 141 ± 45 ng·mL−1; P < 0.001 for both).
Conclusions
In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflurane.
Résumé
Objectif
La réaction au stress chirurgical dépend, entre autres, de l’importance du traumatisme chirurgical, du type d’intervention (laparoscopie vs laparotomie) et d’anesthésie. Nous voulions comparer les changements hormonaux pendant et après l’opération sous anesthésie à l’isoflurane, ou au sévoflurane, selon un modèle clinique bien défini de stress opératoire (intervention chirurgicale par laparoscopie pelvienne).
Méthode
L’étude clinique, prospective et randomisée, a été faite auprès de 20 femmes devant subir une intervention par laparoscopie pelvienne pour des kystes bénins de l’ovaire. Les patientes ont reçu, soit une anesthésie normale à l’isoflurane avec du fentanyl (groupe A), soit au sévoflurane avec du fentanyl (groupe B). Le sang a été prélevé avant l’opération, 30 min après le début, à la fin après l’extubation et, deux et quatre heures après l’opération. Les niveaux plasmatiques peropératoire et postopératoire de noradrénaline, d’adrénaline, d’hormone adrénocorticotrope (ACTH), de cortisol, d’hormone de croissance GH) et de prolactine (PRL) ont été mesurés.
Résultats
Les niveaux de catécholamine et la douleur postopératoire ont été similaires dans les deux groupes. Néanmoins, comparé au groupe A, le groupe B a affiché une baisse significative d’ACTH, de cortisol et de GH (A vs B à la fin de l’opération: ACTH 160 ± 45 vs 100 ±40 pg·mL−1; cortisol 45 ±8 vs 23 ±7 μg·dL−1; GH 3 ± 2 vs 0,8 ± 0,4 ng·mL−1; P < 0,001 pour toutes), et une hausse de PRL (A vs B, 30 min après le début de l’opération: 139 ± 54 vs 185 ± 22 ng·mL−1; à la fin de l’opération: 100 ± 27 vs 141 ± 45 ng·m−1; P < 0,001 pour les deux).
Conclusion
Dans le cadre clinique d’une intervention laparoscopique de faible stress, le type d’anesthésique volatil utilisé a un effet significatif sur la réaction de stress; les changements associés au sévoflurane montrent une réaction immunitaire et métabolique plus favorable qu’avec l’isoflurane.
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Supported by research funds of the Department of Anesthesiology.
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Marana, E., Annetta, M.G., Meo, F. et al. Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery. Can J Anesth 50, 348–354 (2003). https://doi.org/10.1007/BF03021031
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DOI: https://doi.org/10.1007/BF03021031