title: [Operative stress during aorto-bifemoral reconstruction as dependent on a type of anesthesia].
abstract: Abdominal aortic reconstruction surgery in patients with arteriosclerosis obliterans usually has been carried out under standard intratracheal anaesthesia and only a some few centres have included continuous suprameningeal anaesthesia. On the basis of that scanty data it seems that combined intratracheal and suprameningeal anaesthesia might have some advantages over the standard anaesthesia owing to reducing general symptoms of perioperative stress. The aim of this study was to investigate the operative stress during abdominal aortic reconstruction in patients with arteriosclerosis obliterans as dependent on a type of anaesthesia: standard intratracheal and combined-intratracheal supported by suprameningeal doses of anaesthetics. The evaluation of a magnitude of perioperative stress was based on determinations standard markers of stress response in serum: cortisol, adrenaline, noradrenaline, somatotropic hormone and glucose as well. The assessment of the stress condition during abdominal aortic reconstruction in patients with arteriosclerosis obliterans might be of a great importance as most of the patients suffer from ischaemic heart disease. Thus, the choice of an optimal perioperative treatment might improve recovery process. Elective abdominal aortic reconstruction with prosthesis implantation were performed in the year 1995 in 42 patients--8 with abdominal aortic aneurysm (AAA) and 34 with aorto-iliac occlusion (AIO) divided at random in 2 comparable groups according to a type of anaesthesia: I--standard, general anaesthesia supported by myorelaxants and by analgetic drugs given intravenously in a postoperative period, II--combined anaesthesia with a standard general anaesthesia fortified by subarachnoid anaesthesia (0.5% bupivacaine with morphine) reaching the T4-T5 dermatome. The case protocol included: duration of surgery, duration of aorta clamping, type of prosthesis, blood loss, fluid balance, serum level of cortisol, adrenaline, noradrenaline, human growth hormone, glucose, blood morphology, and total creatine kinase activity. Analysing of mean levels of stress markers has shown that they have been lower in combined anaesthesia. It seems that combined anaesthesia is better than the standard anaesthesia owing to reducing general symptoms of perioperative stress.
authors.affiliation: Kliniki Chirurgii Ogólnej i Naczyniowej Akademii Medycznej w Lodzi.
authors.forename: D
authors.initials: D
authors.lastname: Pakuła
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D001012:Aorta, Abdominal / Q000601:surgery*; D001162:Arteriosclerosis Obliterans / Q000601:surgery*; D004837:Epinephrine / Q000097:blood*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013315:Stress, Psychological / Q000097:blood*; D013514:Surgical Procedures, Operative / Q000379:methods*
chemical_list: D004837:Epinephrine