Department of Anesthesiology and Intensive Care Medicine, Sacro Cuore Catholic University, 00168 Rome, Italy.
Minerva Anestesiol. 2013 Jan;79(1):7-14. Epub 2012 Oct 22.
Neurohumoral, immunologic and metabolic alteration characterize surgical procedures in relation with the intensity of injury, the total operating time and the anesthetic technique. We, therefore, compared the effects of desflurane versus sevoflurane anesthesia on intra and postoperative release of the stress hormones and inflammatory cytokines.
Fifty Caucasian women undergoing laparoscopic surgery for benign ovarian cysts were randomized to receive inhaled anesthesia 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).
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. While, the consequent increase of ACTH was significantly higher in the SEVO group at T2-T4. The preoperatory levels were restored at T5. Glucose, IL-6, CRP levels and postoperative pain did not show significant differences in timing within the same group and comparing DES vs SEVO group.
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.
神经体液、免疫和代谢改变与损伤程度、总手术时间和麻醉技术有关，这些改变是手术的特征。因此，我们比较了地氟烷与七氟烷麻醉对术中及术后应激激素和炎症细胞因子释放的影响。
50 例白人女性因良性卵巢囊肿接受腹腔镜手术，随机分为地氟烷（DES 组，n=25）或七氟烷（SEVO 组，n=25）吸入麻醉，芬太尼推注和瑞芬太尼输注。分别于术前（T1）、手术开始后 30 分钟（T2）、手术结束后 30 分钟、2 小时和 4 小时（T3、T4、T5）测量去甲肾上腺素、肾上腺素、ACTH 和皮质醇的血浆水平。在 T1、T2、T3、T4、T5 和手术结束后 12 小时（T6）测量白细胞介素 6（IL-6）、葡萄糖和 C 反应蛋白（CRP）。
两组在手术期间（T2）和手术后立即（T3）均观察到儿茶酚胺升高。然而，DES 组的肾上腺素和去甲肾上腺素水平明显高于 SEVO 组。尽管两组的皮质醇浓度均有所下降，但仅在 DES 组术中与基线水平和 SEVO 组相比有显著差异。同时，在 T2-T4 时 SEVO 组 ACTH 的升高更为显著。T5 时恢复术前水平。葡萄糖、IL-6、CRP 水平和术后疼痛在同一组内的时间内没有显著差异，DES 与 SEVO 组之间也没有显著差异。
在本研究中，我们证明了地氟烷和七氟烷在腹腔镜手术中产生了不同的应激反应。地氟烷麻醉时儿茶酚胺的释放增加可能对伴有心血管疾病的患者产生不良影响。在低应激手术中，与七氟烷相比，地氟烷与术中皮质醇和 ACTH 反应的更好控制相关（T2）。此外，术后 ACTH 分泌也减弱（T3-T4）。两种气体均不影响血浆中 Il-6、CRP 和葡萄糖的水平。
