Document Detail


Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy.
MedLine Citation:
PMID:  9805694     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To evaluate and compare the stress hormone responses during laparoscopic cholecystectomy during general anesthesia, general anesthesia supplemented by fentanyl, and general anesthesia combined with epidural anesthesia. DESIGN: Prospective, randomized clinical study. SETTING: Operating rooms at a municipal hospital. PATIENTS: 52 ASA physical status I and II patients. INTERVENTIONS: Anesthesia was induced slowly with sevoflurane and nitrous oxide (N2O) in oxygen (O2) by mask. Endotracheal intubation was facilitated with intravenous (i.v.) vecuronium 0.1 mg/kg. In 17 patients, anesthesia was maintained with sevoflurane and 50% N2O in O2. For another 18 patients, fentanyl 4 micrograms/kg was administered after endotracheal intubation, and anesthesia was maintained with sevoflurane and 50% N2O in O2. The remaining 17 patients received thoracic epidural anesthesia (1% mepivacaine in an 8 ml bolus followed by a continuous infusion of 1% mepivacaine, 3 ml/hr) after endotracheal inturbation, and general anesthesia was maintained with sevoflurane and 50% N2O in O2. End-tidal sevoflurane concentrations were adjusted to maintain mean arterial pressure between 70% and 100% of preinduction values. MEASUREMENTS AND MAIN RESULTS: Venous blood was sampled for measurements of cortisol and catecholamines (epinephrine and norepinephrine) immediately before and 30 minutes after surgical incision. Cortisol levels increased in all three anesthesia techniques. Both catecholamines increased in patients receiving general anesthesia only; catecholamines did not increase significantly in patients receiving general anesthesia combined with epidural anesthesia; in patients receiving general anesthesia supplemented with fentanyl, both catecholamines increased significantly, but the degree of increase in norepinephrine was less than that in the general anesthesia only group. CONCLUSIONS: The fentanyl supplemented group received relatively small doses insufficient to inhibit an increase in catecholamines. Thoracic epidural anesthesia depressed the sympathetic response presumably by blocking afferent sympathetic pathways under the conditions of this study. However, it did not attenuate an increase in cortisol, one of the hypothalamic-pituitary-adrenal stress hormones, during carbon dioxide laparoscopic cholecystectomy in our study. This action may be due to the inability of epidural anesthesia to block phrenic nerves that can convey noxious surgical stimulation to the central nervous system.
Authors:
H Aono; A Takeda; S D Tarver; H Goto
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  10     ISSN:  0952-8180     ISO Abbreviation:  J Clin Anesth     Publication Date:  1998 Nov 
Date Detail:
Created Date:  1999-02-11     Completed Date:  1999-02-11     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  546-50     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology, University of Kansas Medical Center, Kansas City 66160-7415, USA.
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MeSH Terms
Descriptor/Qualifier:
Anesthesia, Epidural
Anesthesia, General* / adverse effects
Blood Gas Analysis
Blood Pressure / drug effects
Carbon Dioxide*
Catecholamines / blood
Cholecystectomy, Laparoscopic*
Female
Heart Rate / drug effects
Humans
Hydrocortisone / blood
Male
Middle Aged
Prospective Studies
Stress, Physiological / blood*,  etiology,  physiopathology
Chemical
Reg. No./Substance:
0/Catecholamines; 124-38-9/Carbon Dioxide; 50-23-7/Hydrocortisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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