Treatment of stress response during balanced anesthesia. Comparative effects of isoflurane, alfentanil, and trimethaphan.
Acute hypertensive responses during nitrous oxide-opioid-relaxant anesthesia are a common clinical problem. In adult men undergoing radical prostatectomy procedures and anesthetized with a standardized technique, we evaluated the effectiveness of alfentanil, isoflurane, and trimethaphan in treating acute hemodynamic and stress hormone responses to surgical stimulation. Stress hormone concentrations were measured 1 min before skin incision, after the onset of an acute hypertensive response, and after returning the mean arterial pressure to within 10% of the preincision values with one of the three treatment modalities. Pretreatment plasma alfentanil concentrations (151 +/- 47 to 156 +/- 47 ng.ml-1) and end-tidal nitrous oxide concentrations (66 +/- 2 to 68 +/- 2%) were similar in all three groups. Acute hypertensive events were associated with significantly increased concentrations of catecholamines and vasopressin (antidiuretic hormone [ADH]). Whereas intravenous alfentanil returned all hormone concentrations to preincision values, norepinephrine and glucose concentrations were significantly increased after adjunctive isoflurane administration. Although trimethaphan decreased the norepinephrine concentration, the epinephrine, beta-endorphin, cortisol, ADH, and glucose concentrations were significantly increased compared to preincision values. However, the persistent elevation in the posttreatment ADH concentration in the trimethaphan group was the only significant difference between the three groups. Mean (+/- standard deviation) times to awakening (2.8 +/- 3.3 to 3.8 +/- 4.2 min), extubation (8.1 +/- 4.8 to 10.3 +/- 8.5 min), and orientation (19.6 +/- 20.4 to 24.6 +/- 19.1 min) were similar in all three groups. Naloxone was required more frequently in patients in the alfentanil (35%) and isoflurane (24%) groups than in the trimethaphan group (4%).(ABSTRACT TRUNCATED AT 250 WORDS)
Monk
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Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110.
Mueller
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White
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D000368:Aged; D015760:Alfentanil / Q000097:blood / Q000627:therapeutic use*; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004837:Epinephrine / Q000097:blood*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D007431:Intraoperative Complications / Q000097:blood / Q000188:drug therapy*; D007530:Isoflurane / Q000097:blood / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D009638:Norepinephrine / Q000097:blood*; D011468:Prostatectomy; D016037:Single-Blind Method; D014294:Trimethaphan / Q000097:blood / Q000627:therapeutic use*; D014667:Vasopressins / Q000097:blood*; D014673:Vecuronium Bromide
D014667:Vasopressins; D015760:Alfentanil; D014294:Trimethaphan; D014673:Vecuronium Bromide; D007530:Isoflurane; D009609:Nitrous Oxide; D009638:Norepinephrine; D004837:Epinephrine