title: Desflurane versus sevoflurane: a comparison on stress response.
abstract: BACKGROUND
  Neurohumoral, immunologic and metabolic alteration characterize surgical procedures in relation with the intensity of injury, the total operating time and the anesthetic technique. We, therefore, compared the effects of desflurane versus sevoflurane anesthesia on intra and postoperative release of the stress hormones and inflammatory cytokines.
  
  
  METHODS
  Fifty Caucasian women undergoing laparoscopic surgery for benign ovarian cysts were randomized to receive inhaled anesthesia with desflurane (DES group; N.=25) or sevoflurane (SEVO group; N.=25), with fentanyl bolus and remifentanil infusion. Plasma levels of noradrenaline, adrenaline, ACTH and cortisol were measured preoperatively (T1), 30 minutes after the beginning of surgery (T2), and 30 minutes, 2 and 4 hours after the end of surgery (T3, T4, T5 respectively). Interleukin 6 (IL-6), glucose and C-reactive protein (CRP) were measured at T1, T2,T3, T4, T5 and 12 hours after the end of surgery (T6).
  
  
  RESULTS
  An increase of catecholamines during (T2) and immediately after surgery (T3) was observed in both groups. However, adrenaline and noradrenaline levels were significantly higher in the DES group compared to the SEVO group. Despite a drop of cortisol concentration was observed in both groups, only in the DES group there was a significant difference intraoperatively as compared to the baseline levels and to the SEVO group. While, the consequent increase of ACTH was significantly higher in the SEVO group at T2-T4. The preoperatory levels were restored at T5. Glucose, IL-6, CRP levels and postoperative pain did not show significant differences in timing within the same group and comparing DES vs SEVO group.
  
  
  CONCLUSIONS
  In the present study we demonstrated that desflurane and sevoflurane produced a different stress response in the setting of laparoscopic surgery. The greater release of catecholamines during desflurane anesthesia could have adverse effects in patients with pre-existing cardiovascular disease. In low stress surgery desflurane, as compared to sevoflurane, was associated with a better control of intraoperative cortisol and ACTH response (T2). Moreover, the ACTH secretion resulted attenuated also postoperatively (T3-T4). Both gases did not influence the plasmatic levels of Il-6, CRP and glucose.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Sacro Cuore Catholic University, 00168 Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Marana
authors.forename: A
authors.initials: A
authors.lastname: Russo
authors.forename: S
authors.initials: S
authors.lastname: Colicci
authors.forename: L
authors.initials: L
authors.lastname: Polidori
authors.forename: F
authors.initials: F
authors.lastname: Bevilacqua
authors.forename: D
authors.initials: D
authors.lastname: Viviani
authors.forename: E
authors.initials: E
authors.lastname: Di Stasio
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D002395:Catecholamines / Q000097:blood; D016207:Cytokines / Q000097:blood; D000077335:Desflurane; D005260:Female; D013509:Gynecologic Surgical Procedures; D006360:Heat-Shock Proteins / Q000378:metabolism; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D010535:Laparoscopy; D008738:Methyl Ethers / Q000009:adverse effects*; D010048:Ovarian Cysts / Q000601:surgery; D010149:Postoperative Pain / Q000453:epidemiology; D000077149:Sevoflurane; D013312:Stress, Physiological / Q000187:drug effects*
chemical_list: D018685:Anesthetics, Inhalation; D002395:Catecholamines; D016207:Cytokines; D006360:Heat-Shock Proteins; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane