Effect of anesthesia on the changes in the hormones levels during and after transvesical prostatectomy.
BACKGROUND
Hypovolemia and pain are direct stimulators of hormonal response to trauma. Thus, neuroendocrine, metabolic and inflammatory aspects of the injury are part of an overall "stress response". In particular, it manifests in patients undergoing surgical intervention. These reactions can occur with trauma, burns, severe infections and physical exertion. Metabolic and neuroendocrine response to surgical intervention depends on several factors, such as severity and duration of the surgical trauma, patient's age, type of anesthesia and surgical techniques.


OBJECTIVE
The aim of this study was to determine and evaluate levels of hormones in patients undergoing transvesical prostatectomy under general or local anesthesia: ACTH, PRL, TSH, T3, T4, cortisol, and to determine the influence of consciousness (in local-regional anesthesia) in relation to the unconscious state in the general balanced anesthesia on hormonal response measured values above mentioned levels of hormones. Determined the level of hormone values during three time periods: before anesthesia, during surgery in enucleation of prostate glandular tissue and 24 hours after surgery.


METHODS
The study included a total of 100 patients from the Clinic of Urology, Clinical Center of Sarajevo who underwent surgery by technique oftransvesical prostatectomy. According to the criteria defined the subjects were divided into two test groups: Group I (n = 50)--patients underwent surgery under general anesthesia, Group II (n = 50)--patients underwent surgery in local-regional anesthesia. The first blood sample was taken at screening purposes just before the introduction of general anesthesia or loco regional anesthesia. The second sample was taken during surgery during enucleation of prostate gland tissue. A third blood sample was taken 24 hours after surgery.


RESULTS
Increased levels of ACTH intraoperative in both anesthesia techniques applied, with a slightly larger increase in the value of the respondents with technique of general anesthesia. The values of ACTH after 24 hours showed a return to preoperative values in case of both techniques of anesthesia. Increased levels of PRL intraoperative in both anesthesia techniques applied, with larger peak values registered in patients under technique of general anesthesia (3554microIJ/L). High levels of PRL are maintained and postoperatively after 24 hours with both techniques applied anesthesia. Increased intraoperative levels of TSH in both anesthetic techniques, with higher maximum values in patients with technique of general anesthesia (7.20 mU/L). The values of TSH postoperatively after 24 hours showed a return to baseline in case of both applied technique of anesthesia. Low intraoperative values of T3 in both anesthetic techniques. Lower values of T3 are still continuing after 24 hours postoperatively in both applied techniques of anesthesia. The values of T4 hormone in subjects under general anesthesia did not show major deviations intraoperatively or postoperatively.


CONCLUSIONS
Regional anesthesia with the present consciousness, but with sympathetic blockade caused a greater suppression of hormonal responses, than the general balanced anesthesia.
Center for Anesthaesia, Clinical Center of University of Sarajevo, Bosnia and Herzegovina.
Ediba
E
Celic-Spuzic
D000324:Adrenocorticotropic Hormone; D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000772:Anesthesia, Local; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D011388:Prolactin / Q000097:blood; D011468:Prostatectomy; D013312:Stress, Physiological; D013963:Thyroid Hormones / Q000097:blood
D006728:Hormones; D013963:Thyroid Hormones; D000324:Adrenocorticotropic Hormone; D011388:Prolactin; D006854:Hydrocortisone