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Canadian Anaesthetists’ Society Journal

, Volume 31, Issue 5, pp 509–516 | Cite as

Hormonal and haemodynamic responses to upper abdominal surgery during isoflurane and balanced anaesthesia

  • Simon Gelman
  • Jorge E. Rivas
  • Hamdi Erdemir
  • Suzanne Oparil
  • James Proctor
  • Thomas MacKrell
  • Lloyd Smith
Reports of Investigation

Abstract

The purpose of the study was to compare the protective role of different anaesthetic techniques against surgical stress. Sixty patients undergoing elective laparotomy were randomly divided into six groups of ten patients each: Group I was given 0.65 MAC nitrous oxide (66 per cent inspired) and 0.65 MAC isoflurane (0.75 per cent end-expired); Group 11 was given 0.65 MAC nitrous oxide and 1-1.2 MAC isoflurane (1.2-1.4 per cent end-expired); Group III was given the same anaesthetic management as patients in Group I but with the addition offentanyl (2 μg’kg-1) before the skin incision and & of the initial dose every 15 minutes during surgery; Group IV was treated as patients in Group I with an additional infusion ofiidocaine (30 μg-kg-1- min-1); Groups V and VI were given 0.65 MAC of nitrous oxide andfentanyl, 7.5 and 15 μ g.kg-1, respectively, before skin incision with 1/8 of the initial dose every 15 minutes during the operation; diazepam, 5 mg IV each hour of surgery, was given to prevent intraoperative awareness. Cortisol concentration was determined by radioimmunoassay method and catecholamines were measured by high performance liquid gas chromatography in blood samples at different stages perioperatively.

All patients had satisfactory haemodynamic courses of anaesthesia. Statistically significant increases in both epinephrine and norepinephrine concentrations were observed during the immediate postoperative period in Group I patients only. Haemodynamic stability was maintained despite a two- to three-fold increase in cortisol which occurred during the operation and immediate postoperative period. More titan I MAC of isoflurane in conjunction with nitrous oxide (Group II) andfentanyl in a loading dose of 15 μg-kg-1 (Group VI) did not show any advantages over other techniques employed, but substantially delayed awakening and extubation.

Key words

Anaesthetic techniques: balanced inhalation Anaesthetics volatile: isoflurane Anaesthetics local: lidocaine complications: stress 

Résumé

Cette étude compare le degré de protection contre le stress chirurgical apporté par diverses approches anes-thésiques. SoLxante patients répartis en six groupes de dix ont été étudiés au cours de laparotomie. Les techniques anesthésiques ont été les suivantes: Gwupe I: proto.xyde d’azote 0.65 MAC (66 pour cent du mélange inspiré) et isoflurane 0.65 MAC (0 75 pour cent en fin d’expiration ).

Groupe II: protoxyde a’azote 0.65 MAC et isoflurane 1-1.2 MAC (1.2 à 1.4 pour en fin d’expiration).

Groupe III: les mêmes concentrations que le groupe I avec addition de fentanyl (2 μg-kg-1 ) avant l’ incision de la peau et le huitième de cette dose aux 15 minutes duraiu la chirurgie.

Groupe IV: même concentration inspirée que pour les patients du groupe I avec infusion additionnelle de lidocafne (30 μg-kg-1Iminute).

Groupes V el VI: protoxyde d’azote 0.65 MAC et fentanyl 7.5 et 15 μg-kg-1 respectivement avant I’incision de la peau et ensuite le huitième de ces doses initiates aux 15 minutes durant I’intervention, 5 mg i.v. de diazépam a été administré à toutes les heures durant I’opération afin d’empêcher la prise de conscience peropêratoire.

Les concentrations de cortisol ont été mesurées par la méthode de titrage radio-immunologique et les catéchol-amines par chromatographie en phase gazeuse stir des échantillons de sang pris aux différentes étapes de étude. Pour tous les groupes, la technique choisie a maintenu une stabiliié hémodynamique satisfaisante durant la chirurgie. Seuls les patients du groupe I ont montré une élévation statistiquement significative des concentrations d’épinéphrine et de norépinéphrine à la période post-opératoire immédiate (deux heures aprè.i la fin de I’intervention). La stabilité hémodynamique s’est maintenue malgré l’augmentation du cortisol qui a doublé ou même triplé pendant I’intervention et durant la période post-opératoire immédiate. Les associations d’isoflurane 1 MAC avec protoxyde d’azote (groupe II) et isoflurane 1 MAC, protoxyde d’azote et fentanyl en dose d’amorce de 15 μg.kg-1 (groupe VI) ne semblent pas présenter d’avantages sur les autres techniques employees et ont contribué à retarder le réveil et le moment de l’extubation.

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Copyright information

© Canadian Anesthesiologists 1984

Authors and Affiliations

  • Simon Gelman
    • 1
  • Jorge E. Rivas
    • 1
  • Hamdi Erdemir
    • 1
  • Suzanne Oparil
    • 1
  • James Proctor
    • 1
  • Thomas MacKrell
    • 1
  • Lloyd Smith
    • 1
  1. 1.Department of AnesthesiologyThe University of Alabama Medical CenterBirmingham

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