Sevoflurane versus isoflurane--anaesthesia for lower abdominal surgery. Effects on perioperative glucose metabolism.
BACKGROUND
The aim of this study was to determine the impact of sevoflurane anaesthesia on metabolic and endocrine responses to lower abdominal surgery.


METHODS
A prospective randomized controlled study in 20 patients undergoing abdominal hysterectomy. Patients were randomly assigned to receive either sevoflurane (S) or isoflurane anaesthesia (I). Using a stable isotope dilution technique, endogenous glucose production (EGP) and plasma glucose clearance (GC) were determined pre- and postoperatively (6,6-2H2-glucose). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured preoperatively, 5 min after induction of anaesthesia, during surgery and 2 h after the operation.


RESULTS
EGP increased in both groups with no intergroup differences (preop. S 12.2 +/- 1.6, I 12.4 +/- 1.6; postop. S 16.3 +/- 1.9*, I 19.0 +/- 3.1* micromol kg(-1) min(-1), all values are means +/- SD, *P < 0.05 vs. preop.). Plasma glucose concentration increased and GC decreased in both groups. There were no differences between groups. (Glucose conc. mmol l(-1) preop.: S 4.1 +/- 0.3, I 3.9 +/- 0.5; 5 AI S 5.1 +/- 0.6*, I 5.1 +/- 1.0*, postop. S 7.0 +/- 1.0*, I 7.1 +/- 1.4*; * = P < 0.05 vs. preop.; GC ml kg(-1)min(-1) preop. S 3.0 +/- 0.4, I 3.2 +/- 0.4; postop. S 2.4 +/- 0.3*, I 2.7 +/- 0.3*; *=P < 0.05 vs. preop.) Insulin plasma concentrations were unchanged. Cortisol plasma concentrations increased intra- and postoperatively with no changes between the groups. Norepinephrine plasma concentration increased in the S group after induction of anaesthesia. I group norepinephrine was increased 2 h after operation and showed no intergroup differences.


CONCLUSIONS
Sevoflurane, as well as isoflurane, does not prevent the metabolic endocrine responses to surgery.
Geisser
W
W
Universitaetsklinik fuer Anaesthesiologie, Universitaetsklinikum Ulm, Germany. wolfgang@geisser.org
Schreiber
M
M
Hofbauer
H
H
Lattermann
R
R
Füssel
S
S
Wachter
U
U
Georgieff
M
M
Schricker
T
T
D000005:Abdomen / Q000601:surgery*; D000210:Acute-Phase Reaction / Q000503:physiopathology; D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001786:Blood Glucose / Q000378:metabolism*; D002395:Catecholamines / Q000097:blood; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D005947:Glucose / Q000493:pharmacokinetics; D006728:Hormones / Q000097:blood; D006801:Humans; D007044:Hysterectomy; D007530:Isoflurane; D019344:Lactic Acid / Q000097:blood; D008738:Methyl Ethers; D008875:Middle Aged; D019990:Perioperative Care; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D001786:Blood Glucose; D002395:Catecholamines; D005230:Fatty Acids, Nonesterified; D006728:Hormones; D008738:Methyl Ethers; D019344:Lactic Acid; D000077149:Sevoflurane; D007530:Isoflurane; D005947:Glucose