Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea.
Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Jongno-gu, Seoul, Korea.
Acta Anaesthesiol Scand. 2020 Sep;64(8):1063-1072. doi: 10.1111/aas.13646. Epub 2020 Jun 9.
Anesthetic techniques can affect perioperative neuroendocrine function. The objective of this study was to compare 3-month post-operative neuroendocrine functional outcomes between sevoflurane and propofol anesthesia in patients undergoing endoscopic transsphenoidal surgery (ETS) for removal of non-functional pituitary adenomas (NFPAs) retrospectively.
Among 356 patients who underwent ETS for removal of NFPAs under sevoflurane-remifentanil anesthesia (sevoflurane group, n = 103) or propofol-remifentanil anesthesia (propofol group, n = 253), 92 patients in each group were selected and their 3-month post-operative neuroendocrine functional outcomes (primary outcome measure) were compared after propensity score matching.
Overall changes in post-operative 3-month neuroendocrine function compared to pre-operative baseline did not differ between the sevoflurane and propofol groups (worsened: 32.6% vs 29.3%, persistently decreased: 9.8% vs 12.0%, improved: 12.0% vs 20.7%, normalized: 9.8% vs 12.0%, persistently normal: 18.5% vs 19.6%; P = .400). The incidence of pituitary hormone deficiency at 3 months post-operatively did not differ between the sevoflurane and propofol groups (adrenocorticotropic hormone deficiency: 18.5% vs 17.4%, P = 1.000; thyroid-stimulating hormone deficiency: 10.9% vs 3.3%, P = .081; gonadotropin deficiency: 54.3% vs 48.9%, P = .555; growth hormone deficiency: 45.7% vs 48.9%, P = .768; panhypopituitarism: 1.1% vs 1.1%, P = 1.000).
In patients undergoing ETS for removal of NFPAs, the effects of both sevoflurane-remifentanil and propofol-remifentanil anesthetic techniques on post-operative 3-month neuroendocrine functional outcomes were similar, suggesting that propofol and sevoflurane can be freely used in such patients in terms of post-operative intermediate-term neuroendocrine functional outcome.
麻醉技术会影响围手术期神经内分泌功能。本研究旨在比较接受内镜经蝶窦手术（ETS）切除无功能性垂体腺瘤（NFPAs）的患者使用七氟醚和丙泊酚麻醉后 3 个月的神经内分泌功能结局。
在 356 例接受七氟醚-瑞芬太尼麻醉（七氟醚组，n=103）或丙泊酚-瑞芬太尼麻醉（丙泊酚组，n=253）行 ETS 切除 NFPAs 的患者中，每组选择 92 例患者，对其术后 3 个月的神经内分泌功能结局（主要结局指标）进行倾向性评分匹配后比较。
与术前基线相比，两组术后 3 个月神经内分泌功能的总体变化无差异（恶化：32.6%比 29.3%，持续减退：9.8%比 12.0%，改善：12.0%比 20.7%，正常化：9.8%比 12.0%，持续正常：18.5%比 19.6%；P=0.400）。术后 3 个月时，两组垂体激素缺乏的发生率无差异（促肾上腺皮质激素缺乏：18.5%比 17.4%，P=1.000；促甲状腺激素缺乏：10.9%比 3.3%，P=0.081；促性腺激素缺乏：54.3%比 48.9%，P=0.555；生长激素缺乏：45.7%比 48.9%，P=0.768；全垂体功能减退：1.1%比 1.1%，P=1.000）。
在接受 ETS 切除 NFPAs 的患者中，七氟醚-瑞芬太尼和丙泊酚-瑞芬太尼麻醉技术对术后 3 个月神经内分泌功能结局的影响相似，提示在术后中期神经内分泌功能结局方面，可自由选择丙泊酚和七氟醚用于此类患者。
