Department of Anesthesiology and Pain Medicine.
Neurosurgery, Pituitary Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
J Neurosurg Anesthesiol. 2021 Apr 1;33(2):137-146. doi: 10.1097/ANA.0000000000000638.
Anesthetic technique affects the neuroendocrine stress response to surgery. In this retrospective study, we compared the neuroendocrine stress response in patients undergoing endoscopic transsphenoidal pituitary adenoma surgery (ETSPAS) with total intravenous anesthesia (TIVA) with propofol-remifentanil or balanced anesthesia (BAL) with sevoflurane-remifentanil.
Eighty-nine patients undergoing ETSPAS were anesthetized with either propofol-remifentanil (TIVA group, n=62) or sevoflurane-remifentanil (BAL group, n=27). Data were retrospectively collected regarding preoperative and immediate postoperative serum levels of adrenocorticotropic hormone (ACTH) and cortisol (primary outcome measures), as well as other pituitary hormones and their target organ hormones (secondary outcome measures).
There were no significant differences in preoperative pituitary hormone levels between the 2 groups. The immediate postoperative ACTH (89.5 [62.1 to 162.6] vs. 256.0 [92.0 to 570.7] pg/mL; P<0.001) level was lower in the TIVA group than in the BAL group, whereas immediate postoperative cortisol levels were similar between the 2 groups. The immediate postoperative thyroid-stimulating hormone (1.85 [1.21 to 2.98] vs. 1.21 [0.44 to 1.71] μIU/mL; P=0.003), triiodothyronine (91.0 [82.0 to 103.0] vs. 69.1 [64.6 to 76.2] ng/dL; P<0.001), luteinizing hormone (2.2 [1.2 to 4.0] vs. 1.0 [0.5 to 2.3] mIU/mL; P=0.005), and prolactin (22.6±15.8 vs. 12.8±10.2 ng/mL; P=0.005) levels were higher in the TIVA group compared with the BAL group. In both groups, none of the patients who had sufficient preoperative ACTH without hydrocortisone supplementation (n=15) showed hypocortisolism in the immediate postoperative measurement.
Compared with BAL, TIVA resulted in reduced release of ACTH and increased release of thyroid-stimulating hormone, triiodothyronine, luteinizing hormone, and prolactin in patients undergoing ETSPAS.
麻醉技术会影响手术对神经内分泌应激的反应。在这项回顾性研究中，我们比较了经蝶窦垂体腺瘤手术（ETSPAS）中接受异丙酚-瑞芬太尼全凭静脉麻醉（TIVA）或七氟醚-瑞芬太尼平衡麻醉（BAL）的患者的神经内分泌应激反应。
89 例行 ETSPAS 的患者接受异丙酚-瑞芬太尼（TIVA 组，n=62）或七氟醚-瑞芬太尼（BAL 组，n=27）麻醉。回顾性收集术前和术后即刻血清促肾上腺皮质激素（ACTH）和皮质醇（主要结局指标）以及其他垂体激素及其靶器官激素（次要结局指标）的数据。
两组患者术前垂体激素水平无显著差异。TIVA 组术后即刻 ACTH 水平（89.5[62.1 至 162.6]pg/mL 比 BAL 组的 256.0[92.0 至 570.7]pg/mL；P<0.001）低于 BAL 组，而两组术后即刻皮质醇水平相似。TIVA 组术后即刻促甲状腺激素（1.85[1.21 至 2.98]μIU/mL 比 BAL 组的 1.21[0.44 至 1.71]μIU/mL；P=0.003）、三碘甲状腺原氨酸（91.0[82.0 至 103.0]ng/dL 比 BAL 组的 69.1[64.6 至 76.2]ng/dL；P<0.001）、黄体生成素（2.2[1.2 至 4.0]mIU/mL 比 BAL 组的 1.0[0.5 至 2.3]mIU/mL；P=0.005）和催乳素（22.6±15.8ng/mL 比 BAL 组的 12.8±10.2ng/mL；P=0.005）水平高于 BAL 组。在两组中，均无术前 ACTH 充足且无需氢化可的松补充的患者（n=15）在术后即刻测量中出现皮质醇不足。
与 BAL 相比，TIVA 可减少 ETSPAS 患者 ACTH 的释放，并增加促甲状腺激素、三碘甲状腺原氨酸、黄体生成素和催乳素的释放。
