title: Combination of epidural anesthesia and general anesthesia attenuates stress response to renal transplantation surgery.
abstract: Choice of the anesthestic technique can reduce or even eliminate stress responses to surgery and decrease the incidence of complications. Our aim was to compare a combination of epidural anesthesia+general anesthesia with general anesthesia alone as regards perioperative insulin resistance and inflammatory activation among renal transplant recipients. Forty-six nondiabetic patients undergoing renal transplantation were prospectively randomized to the epidural anesthesia + general anesthesia group (n = 21), or general anesthesia alone group (n = 25). Plasma levels of glucose, insulin, interleukin (IL)-6, tumour necrosis factor (TNF)-α, resistin, and adiponectin were measured at baseline (T1), end of surgery (T2), postoperative first hour (T3), postoperative second hour (T4) and postoperative 24th hour (T5). Homeostasis model assessment-estimated insulin resistance (HOMA-IR) scores were calculated at every time point that the blood samples were collected. Glucose levels (P < .001) and insulin levels at the end of surgery (P = .048) and at postoperative first hour (P = .005) and HOMA-IR levels at the end of surgery (P = .012) and at postoperative first hour (P = .010) showed significantly higher values among the general anesthesia alone group when compared with the epidural+general anesthesia group. TNF-α levels at postoperative 2nd and at 24th hour (P = .005 and P = .004, respectively) and IL-6 levels at postoperative 1st and 2nd hours (P = .002 and P = .045, respectively) were significantly higher in the general anesthesia alone group when compared with the epidural+general anesthesia group. The TNF-α levels were significantly less at all time points when compared with baseline only in the epidural+general anesthesia group (T1, 33.36 vs 37.25; T2, 18.45 vs 76.52; T3, 15.18 vs 78.27; T4, 10.75 vs 66.64; T5, 2.98 vs 36.32) Hospital stays were significantly shorter among the epidural+general anesthesia group (P = .022). We showed partly attenuated surgical stress responses among patients undergoing renal transplantation using general anesthesia combined with epidural anesthesia compared with general anesthesia alone.
authors.affiliation: Department of Anesthesiology and Reanimation, Akdeniz University Hospital, Antalya, Turkey. necmiye@akdeniz.edu.tr
authors.forename: N
authors.initials: N
authors.lastname: Hadimioglu
authors.forename: H
authors.initials: H
authors.lastname: Ulugol
authors.forename: H
authors.initials: H
authors.lastname: Akbas
authors.forename: N
authors.initials: N
authors.lastname: Coskunfirat
authors.forename: Z
authors.initials: Z
authors.lastname: Ertug
authors.forename: A
authors.initials: A
authors.lastname: Dinckan
mesh_terms: D052242:Adiponectin / Q000097:blood; D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000517:prevention & control; D018836:Inflammation Mediators / Q000097:blood; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D015850:Interleukin-6 / Q000097:blood; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D052243:Resistin / Q000097:blood; D013312:Stress, Physiological; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014421:Turkey
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers; D001786:Blood Glucose; C508600:IL6 protein, human; D018836:Inflammation Mediators; D007328:Insulin; D015850:Interleukin-6; C499624:RETN protein, human; D052243:Resistin; D014409:Tumor Necrosis Factor-alpha