[The influence of cyclo-oxygenase inhibitor and spinal anesthesia on the surgical stress responses during lower abdominal surgery].
In order to evaluate the influence of cyclooxygenase inhibitor and spinal anesthesia on the neuroendocrine responses to surgical stress, plasma levels of prostanoids (6-keto-PGF1 alpha, TXB2, and 11-DTX), stress hormones (ACTH, cortisol), and catecholamines (epinephrine, norepinephrine) were measured in 24 patients undergoing colo-rectal surgery. In group I patients (n = 8) who had received indomethacin preoperatively, the elevation of plasma levels of prostanoids were almost abolished, but plasma levels of stress hormones and catecholamines increased 30 min after skin incision and remained at high levels during the study. In group S (n = 8) patients who received general anesthesia combined with spinal anesthesia, the elevation of plasma levels of TXB2, and 11-DTX were attenuated, and plasma levels of cortisol and catecholamines showed no significant changes up to the postoperative period. In group C (control group) (n = 8) patients, plasma levels of prostanoids, stress hormones, and catecholamines increased significantly 30 min after skin incision, and remained at high levels during the study. These results suggest that 1) TXA2 production may be influenced by the activation of the sympathetic nervous system, 2) PGI2 production may be mainly influenced by the mechanical stimuli to the splanchnic organs during surgical procedure, 3) indomethacin pretreatment reduces inflammatory response but does not reduce endocrine and sympathetic response, and 4) spinal anesthesia attenuates both inflammatory response and sympathetic nerve activation, i.e. sympathetic nerve stimuli plays a predominant role in activating both prostanoids and stress hormone cascades during lower abdominal surgery.
Ogura
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Department of Anesthesiology, Nippon Medical School, Tokyo.
D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D000775:Anesthesia, Spinal; D002395:Catecholamines / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000378:metabolism / Q000601:surgery*; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011453:Prostaglandins / Q000378:metabolism; D013564:Sympathetic Nervous System / Q000502:physiology
D002395:Catecholamines; D016861:Cyclooxygenase Inhibitors; D011453:Prostaglandins; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone