title: Sevoflurane versus isoflurane--anaesthesia for lower abdominal surgery. Effects on perioperative glucose metabolism.
abstract: 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.
authors.affiliation: Universitaetsklinik fuer Anaesthesiologie, Universitaetsklinikum Ulm, Germany. wolfgang@geisser.org
authors.forename: W
authors.initials: W
authors.lastname: Geisser
authors.forename: M
authors.initials: M
authors.lastname: Schreiber
authors.forename: H
authors.initials: H
authors.lastname: Hofbauer
authors.forename: R
authors.initials: R
authors.lastname: Lattermann
authors.forename: S
authors.initials: S
authors.lastname: Füssel
authors.forename: U
authors.initials: U
authors.lastname: Wachter
authors.forename: M
authors.initials: M
authors.lastname: Georgieff
authors.forename: T
authors.initials: T
authors.lastname: Schricker
mesh_terms: 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
chemical_list: 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