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Desflurane versus sevoflurane: a comparison on stress response.
MedLine Citation:
PMID:  23090102     Owner:  NLM     Status:  Publisher    
BACKGROUND: Neurohumoral, immunologic and metabolic alteration characterize surgical procedures in relation with the intensity of injury, the total operating time and the anaesthetic technique. We therefore compared the effects of desflurane versus sevoflurane anaesthesia on intra and postoperative release of the stress hormones and inflammatory cytokines. MATERIAL AND METHODS: Fifty Caucasian women undergoing laparoscopic surgery for benign ovarian cysts were randomized to receive inhaled anaesthesia with desflurane (DES group; n = 25) or sevoflurane (SEVO group; n = 25), with fentanyl bolus and remifentanil infusion. Plasma levels of noradrenaline, adrenaline, ACTH and cortisol were measured preoperatively (T1), 30 minutes after the beginning of surgery (T2), and 30 minutes, 2 and 4 hours after the end of surgery (T3, T4, T5 respectively). Interleukin 6 (IL-6), glucose and C-reactive protein (CRP) were measured at T1, T2,T3, T4, T5 and 12 hours after the end of surgery (T6). RESULTS: An increase of catecholamines during (T2) and immediately after surgery (T3) was observed in both groups. However, adrenaline and noradrenaline levels were significantly higher in the DES group compared to the SEVO group. Despite a drop of cortisol concentration was observed in both groups, only in the DES group there was a significant difference intraoperatively as compared to the baseline levels and to the SEVO group. Whereas, the consequent increase of ACTH was significantly higher in the SEVO group at T2-T4. The pre-operatory levels were restored at T5. Glucose, IL-6, CRP levels and postoperative pain didn't show significant differences in timing within the same group and comparing DES vs SEVO group. CONCLUSIONS: In the present study we demonstrated that Desflurane and Sevoflurane produced a different stress response in the setting of laparoscopic surgery. The greater release of catecholamines during Desflurane anesthesia could have adverse effects in patients with pre-existing cardiovascular disease. In low stress surgery desflurane, as compared to sevoflurane, was associated with a better control of intraoperative cortisol and ACTH response (T2). Moreover, the ACTH secretion resulted attenuated also postoperatively (T3-T4). Both gases did not influence the plasmatic levels of Il-6, CRP and glucose.
E Marana; A Russo; S Colici; L Polidori; F Bevilacqua; D Viviani; E Di Stasio
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-22
Journal Detail:
Title:  Minerva anestesiologica     Volume:  -     ISSN:  1827-1596     ISO Abbreviation:  Minerva Anestesiol     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Anaesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Rome, Italy -
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