title: Spinal-general anaesthesia decreases neuroendocrine stress response in laparoscopic cholecystectomy.
abstract: OBJECTIVE
  A randomized clinical study to compare the stress response to laparoscopic cholecystectomy during spinal-general anaesthesia and epidural- general anaesthesia.
  
  
  METHODS
  Women undergoing elective laparoscopic chole cystectomy were assigned to receive either spinal anaesthesia (SA group; n = 12) or epidural anaesthesia (EA group; n = 12), in addition to general anaesthesia. Plasma concentrations of cortisol, adrenocorticotrophic hormone (ACTH), noradrenaline, adrenaline and total catecholamines were measured pre- and intraoperatively.
  
  
  RESULTS
  Intraoperative cortisol, noradrenaline and total catecholamine levels were significantly lower in the SA group compared with the EA group. When pre- and intraoperative values were compared, the SA group showed a decrease in adrenaline, noradrenaline and total catecholamine levels, and the EA group showed an increase in ACTH and noradrenaline levels.
  
  
  CONCLUSIONS
  The type of regional anaesthesia significantly affected the stress response: spinal anaesthesia produced a more favourable endocrine response than epidural anaesthesia. Spinal-general anaesthesia may reduce postoperative morbidity in laparoscopic cholecystectomy.
authors.affiliation: Department of Anaesthesia, General Family Medicine and Zone Hospital No. 1, Mexican Social Security Institute, Colima, Mexico.
authors.forename: P
authors.initials: P
authors.lastname: Calvo-Soto
authors.forename: A
authors.initials: A
authors.lastname: Martínez-Contreras
authors.forename: B Trujillo
authors.initials: BT
authors.lastname: -Hernández
authors.forename: Fj Peraza-Garay
authors.initials: FP
authors.lastname: And
authors.forename: C
authors.initials: C
authors.lastname: Vásquez
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D002395:Catecholamines / Q000097:blood; D017081:Cholecystectomy, Laparoscopic; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D009490:Neurosecretory Systems / Q000502:physiology*; D009638:Norepinephrine / Q000097:blood; D013312:Stress, Physiological; D013315:Stress, Psychological / Q000097:blood
chemical_list: D002395:Catecholamines; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine