title: Surgical stress hormones response is reduced after awake videothoracoscopy.
abstract: This study was undertaken to assess stress hormones response after awake videoassisted thoracoscopic surgery (VATS). Plasma levels of adrenal-corticotropic hormone (ACTH), cortisol, epinephrine, norepinephrine, and glucose were assessed at baseline, 3 h postoperatively (T1), and on postoperative mornings 2 (T2) and 3 (T3) in 21 patients undergoing awake VATS with epidural anesthesia for non-malignant conditions (n=11) or equivalent procedures performed with general anesthesia. Epinephrine level peaked in both groups at T1, although significant change from baseline values occurred in the control group only [median-Delta: 6 ng/l (IQR: 4-6), P=0.005]. Cortisol level was lower in the study group at T1 (15.5 microg/dl vs. 23.0 microg/dl, P=0.001) and T2 (15.2 microg/dl vs. 19.2 microg/dl, P=0.002). In the control group, peak cortisol level proved not to be related to changes in ACTH (R=0.23, P=0.46). At T2, glucose (137 mg/dl vs. 98 mg/dl, P=0.01) and C-reactive protein (P=0.04) were higher in the control group. No other clinically relevant between-groups differences were found in aspecific acute-response factors. Overall, these preliminary findings suggest attenuated stress response after awake VATS in comparison with equivalent procedure performed under general anesthesia and one-lung ventilation.
authors.affiliation: Division of Thoracic Surgery, Fondazione Policlinico Tor Vergata, Tor Vergata University School of Thoracic Surgery, Rome, Italy. tacconifederico@libero.it
authors.forename: Federico
authors.initials: F
authors.lastname: Tacconi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.forename: Francesco
authors.initials: F
authors.lastname: Sellitri
authors.forename: Tommaso C
authors.initials: TC
authors.lastname: Mineo
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D015331:Cohort Studies; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008171:Lung Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D010865:Pilot Projects; D011184:Postoperative Period; D011336:Probability; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D013312:Stress, Physiological; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006728:Hormones; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine