Leptin and perioperative neuroendocrine stress response with two different anaesthetic techniques.
BACKGROUND
Stress response to surgery is modulated by several factors, including magnitude of the injury, pain, type of procedure and choice of anaesthesia. Our purpose was to compare intra- and post-operative hormonal changes during total intravenous anaesthesia (TIVA) using propofol and remifentanil vs. sevoflurane anaesthesia in a low stress level surgical model (laparoscopy).


METHODS
We randomly allocated 18 patients undergoing laparoscopic surgery for benign ovarian cysts in two groups to receive either TIVA (group A=9) or sevoflurane anaesthesia (group B=9). Perioperative plasma levels of norepinephrine (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol and leptin were measured. Blood samples were collected pre-operatively (time 0), 30 min after the beginning of surgery (time 1), after extubation (time 2), and 2 h (time 3) and 4 h after surgery (time 4).


RESULTS
The comparative analysis between the groups shows significantly higher values of NE (P<0.001 at time 1 and P<0.01 at time 3), E (P<0.001 at times 1 and 2; P<0.01 at time 3 and P<0.05 at time 4), ACTH (P<0.001 at times 1 and 2; P<0.05 at time 3) and cortisol (P<0.001 at times 1 and 2; P<0.01 at time 3; P<0.05 at time 4) in group B. The serum values of leptin were not significantly different between the two groups.


CONCLUSIONS
The choice of anaesthesia does not seem to affect the leptin serum levels but influences the release of stress response markers: ACTH, cortisol, NE and E.
Marana
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Department of Anesthesiology, Intensive Care and Emergency Medicine, Rome, Italy. elisabetta.marana@rm.unicatt.it
Scambia
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Colicci
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Maviglia
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Maussier
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Marana
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Proietti
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D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000187:drug effects; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D019162:Anesthetics, Combined / Q000494:pharmacology; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D002395:Catecholamines / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D010535:Laparoscopy / Q000379:methods; D020738:Leptin / Q000097:blood*; D008738:Methyl Ethers / Q000494:pharmacology; D008991:Monitoring, Physiologic / Q000379:methods; D009490:Neurosecretory Systems / Q000187:drug effects*; D009638:Norepinephrine / Q000097:blood; D010048:Ovarian Cysts / Q000601:surgery; D019990:Perioperative Care / Q000379:methods*; D010880:Piperidines / Q000494:pharmacology; D015742:Propofol / Q000494:pharmacology; D000077208:Remifentanil; D000077149:Sevoflurane; D013997:Time Factors
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002395:Catecholamines; D020738:Leptin; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000324:Adrenocorticotropic Hormone; D000077208:Remifentanil; D006854:Hydrocortisone; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine