title: Combination of remifentanil with isoflurane or propofol: effect on the surgical stress response.
abstract: BACKGROUND
  Hormonal and metabolic changes following surgery are markers of the stress response to surgery. We compared hemodynamic parameters and stress response markers (glucose, cortisol, and C-reactive protein) in two groups of patients receiving either propofol or isoflurane combined with remifentanil for maintenance of anesthesia.
  
  
  METHODS
  We randomly assigned 100 women (ASA I-II) scheduled for diagnostic gynecologic laparoscopy to receive either isoflurane (0.8% end-tidal) or propofol (100 mg/kg/min) in addition to remifentanil (0.25 mg/ kg/min). Heart rate and mean arterial pressure were recorded after induction, 30 seconds after intubation, at four time points after incision, and 60 min after surgery. Serum C-reactive protein, cortisol and glucose concentrations were measured before induction, one hour after incision, and one hour after surgery.
  
  
  RESULTS
  After induction, heart rate decreased significantly from baseline in both groups, and remained below baseline until the end of surgery. Mean arterial pressure also decreased significantly in both groups. C-reactive protein levels were not significantly different between groups. In the propofol group, cortisol decreased significantly one hour after incision, but increased in the isoflurane group. Glucose increased significantly in both groups, but was significantly lower in the propofol group one hour after the incision and one hour after surgery.
  
  
  CONCLUSIONS
  An anesthetic regimen combining propofol and remifentanil attenuates two indicators of the stress response more efficiently than a isoflurane - remifentanil combination.
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran. azamatis@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Azemati
authors.forename: M
authors.initials: M
authors.lastname: Savai
authors.forename: M B
authors.initials: MB
authors.lastname: Khosravi
authors.forename: E
authors.initials: E
authors.lastname: Allahyari
authors.forename: F
authors.initials: F
authors.lastname: Jahanmiri
mesh_terms: D000328:Adult; D019162:Anesthetics, Combined / Q000097:blood / Q000494:pharmacology*; D018685:Anesthetics, Inhalation / Q000097:blood / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000097:blood / Q000494:pharmacology; D062186:Arterial Pressure / Q000187:drug effects; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects; D002097:C-Reactive Protein; D005260:Female; D013509:Gynecologic Surgical Procedures; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007530:Isoflurane / Q000097:blood / Q000494:pharmacology*; D010880:Piperidines / Q000097:blood / Q000494:pharmacology*; D015742:Propofol / Q000097:blood / Q000494:pharmacology*; D000077208:Remifentanil; D013312:Stress, Physiological / Q000187:drug effects*
chemical_list: D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D001786:Blood Glucose; D010880:Piperidines; D002097:C-Reactive Protein; D007530:Isoflurane; D000077208:Remifentanil; D006854:Hydrocortisone; D015742:Propofol