Stress hormone changes in general anesthesia of long duration: isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia.
OBJECTIVE
There are few comparative studies of stress hormone changes during general anesthesia with long duration between isoflurane-nitrous oxide and sevoflurane-nitrous oxide anesthesia. We investigated perioperative changes of stress hormone in these two anesthetic methods with duration of more than 10 hours.


METHODS
Prospective study.


METHODS
Operating room and high care unit of a university hospital.


METHODS
Twenty patients with ASA physical status I or II for surgery for laryngeal or pharyngeal cancer with expected duration of more than 10 hours.


METHODS
Anesthesia was induced with midazolam, thiopental, and vecuronium and was maintained with sevoflurane (sevoflurane group) or isoflurane (isoflurane group) with nitrous oxide 4 L/min in oxygen 2 L/min.


RESULTS
Plasma concentrations of epinephrine, norepinephrine, cortisol, adrenocorticotropic hormone, and anti-diuretic hormone (ADH); serum concentrations of glucagon and insulin; and blood glucose concentration were measured before inhalation of anesthetics, after 5 and 10 hours, and at 1, 6, and 12 hours after the end of inhalation. Epinephrine and norepinephrine concentrations increased continuously during and after surgery in the isoflurane group whereas it increased only after surgery in the sevoflurane group. Both concentrations were higher in the isoflurane group during anesthesia. Cortisol increased continuously whereas adrenocorticotropic hormone increased only during surgery. Anti-diuretic hormone increased with its peak during surgery and the isoflurane group had significantly higher values than the sevoflurane group. Glucose increased both during and after surgery, insulin increased only after surgery, and glucagon decreased during surgery in both groups.


CONCLUSIONS
In inhalation anesthesia with the duration of more than 10 hours, isoflurane-nitrous oxide and sevoflurane-nitrous oxide had the same effects on stress hormone changes except for epinephrine, norepinephrine, and ADH. Epinephrine, norepinephrine, and ADH concentrations were higher in isoflurane-nitrous oxide anesthesia.
Nishiyama
Tomoki
T
Department of Anesthesiology, Faculty of Medicine, The University of Tokyo, 113-8655 Tokyo, Japan. nishit-tky@umin.ac.jp
Yamashita
Koichi
K
Yokoyama
Takeshi
T
D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000187:drug effects; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D019162:Anesthetics, Combined / Q000009:adverse effects* / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000009:adverse effects* / Q000494:pharmacology; D001786:Blood Glucose / Q000187:drug effects; D004837:Epinephrine / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood / Q000187:drug effects; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D007530:Isoflurane / Q000009:adverse effects* / Q000494:pharmacology; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects* / Q000494:pharmacology; D008875:Middle Aged; D009609:Nitrous Oxide / Q000009:adverse effects* / Q000494:pharmacology; D011446:Prospective Studies; D000077149:Sevoflurane; D013312:Stress, Physiological / Q000139:chemically induced*; D013997:Time Factors
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D001786:Blood Glucose; D006728:Hormones; D007328:Insulin; D008738:Methyl Ethers; D000077149:Sevoflurane; D000324:Adrenocorticotropic Hormone; D005934:Glucagon; D007530:Isoflurane; D009609:Nitrous Oxide; D006854:Hydrocortisone; D004837:Epinephrine