title: [Comparison of intraoperative stress hormones release between propofol-remifentanil anesthesia and propofol with epidural anesthesia during gynecological surgery].
abstract: BACKGROUND
  Remifentanil recently comes to be used for intraoperative analgesia instead of epidural anesthesia in gynecological surgery. It seems to offer the same stability in vital signs, but stress response during remifentanil anesthesia has not been evaluated. Therefore, we compared remifentanil anesthesia with epidural anesthesia regarding stress hormones.
  
  
  METHODS
  Fifty-one patients scheduled for surgery were randomized into two groups (epidural group: E and remifentanil group: R). Anesthesia was maintained with propofol and epidural ropivacaine in E, and with propofol and remifentanil in R. Plasma concentrations of adrenaline, noradrenaline, dopamine (DOA), cortisol, adorenocorticotropic hormone (ACTH), and blood glucose were measured at five points during the perioperative period.
  
  
  RESULTS
  Adrenaline, noradrenaline and blood glucose were not significantly different between the groups at any point. DOA was significantly higher in R than E at skin closure. Cortisol was significantly higher in R than E at three points during operation. ACTH was significantly higher in E than R at skin closure.
  
  
  CONCLUSIONS
  The inhibition of stress hormone secretion during operation was less in R than E. Regarding stress response, total intravenous anesthesia with remifentanil seems to be a proper method, but to have less potency than general anesthesia using epidural block.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075.
authors.forename: Izumi
authors.initials: I
authors.lastname: Kawagoe
authors.forename: Keiko
authors.initials: K
authors.lastname: Tajima
authors.forename: Masanori
authors.initials: M
authors.lastname: Kanai
authors.forename: Snoko
authors.initials: S
authors.lastname: Kimura
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Mitsuhata
mesh_terms: D000767:Anesthesia, Epidural / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001786:Blood Glucose / Q000032:analysis; D004298:Dopamine / Q000097:blood*; D004837:Epinephrine / Q000097:blood*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007432:Intraoperative Period; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D013312:Stress, Physiological / Q000502:physiology
chemical_list: D018686:Anesthetics, Intravenous; D001786:Blood Glucose; D010880:Piperidines; D000077208:Remifentanil; D004298:Dopamine; D006854:Hydrocortisone; D009638:Norepinephrine; D015742:Propofol; D004837:Epinephrine