Neuroendocrine stress response in gynecological laparoscopy: TIVA with propofol versus sevoflurane anesthesia.
OBJECTIVE
To compare intraoperative and postoperative neuroendocrine stress responses during total intravenous anesthesia (TIVA) using propofol and remifentanil versus sevoflurane anesthesia, during laparoscopic surgery.


METHODS
Prospective, randomized study.


METHODS
Tertiary-care university hospital.


METHODS
46 ASA physical status I patients undergoing laparoscopic surgery for benign ovarian cysts.


METHODS
Patients were randomly allocated to two groups to receive either TIVA (Group A=23) or sevoflurane anesthesia (Group B=23).


METHODS
Perioperative plasma levels of norepinephrine (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), prolactin (PRL), and thyroid hormones (TSH, FT3, FT4) were measured. Blood samples were collected preoperatively, 30 minutes after the beginning of surgery, after extubation, and two and 4 hours after the end of surgery (times 0, 1, 2, 3, and 4).


RESULTS
In Group A, perioperative levels of NE, E, ACTH, cortisol, and GH compared with preoperative values significantly decreased; in Group B they increased (Groups A vs. B: time 1, P<0.001 for all markers; time 2, P<0.001 for E, ACTH, cortisol, and GH; time 3, P<0.01 for cortisol, NE, and E, and P<0.05 for ACTH and GH). Perioperative PRL levels were significantly enhanced in both groups versus preoperative values. In both groups, TSH levels increased while FT3 levels decreased significantly relative to basal values. In both groups, perioperative FT4 levels significantly increased compared with preoperative values.


CONCLUSIONS
TIVA inhibited the ACTH-cortisol axis and reduced NE, E, and GH levels, but it enhanced PRL and had a weak effect on thyroid hormone concentrations as compared to sevoflurane anesthesia.
Department of Anesthesiology, Intensive Care and Emergency Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy.
Elisabetta
E
Marana
Stefania
S
Colicci
Francesco
F
Meo
Riccardo
R
Marana
Rodolfo
R
Proietti
D000328:Adult; D019162:Anesthetics, Combined / Q000009:adverse effects / Q000627:therapeutic use; D018685:Anesthetics, Inhalation / Q000009:adverse effects* / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008738:Methyl Ethers / Q000009:adverse effects / Q000627:therapeutic use; D016343:Monitoring, Intraoperative / Q000379:methods; D009490:Neurosecretory Systems / Q000187:drug effects*; D010880:Piperidines / Q000009:adverse effects / Q000627:therapeutic use; D015742:Propofol / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane; D016037:Single-Blind Method; D055815:Young Adult
D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol