title: The Effects of Different Anaesthetic Techniques on Surgical Stress Response During Inguinal Hernia Operations.
abstract: OBJECTIVE
  The aim of this study is to compare the effects of 3 different kinds of anaesthesia on stress response induced by surgery.
  
  
  METHODS
  Sixty patients aged between 25-70 American Society of Anesthesiologists (ASA) I-II group to undergo inguinal herniography were included in this study. Patients were randomly divided into 3 groups of 20. Group 1 received general anaesthesia with sevoflurane/air/remifentanil, patients in Group 2 received total intravenous anaesthesia (TIVA) with propofol/air/remifentanil and Group 3 received spinal anaesthesia induced by hyperbaric bupivacaine, adjoined by remifentanil sedation. Mean arterial pressure (MAP), heart rate and SpO2 values were recorded preoperatively, intraoperatively and postoperatively at certain periods. Cortisol, leptin and glucose levels were preoperatively detected. Intervals were as; 15 minutes prior to the induction of anaesthesia, at intraoperative first hour and at the postoperative third and twenty-forth hours.
  
  
  RESULTS
  MAP and heart rate values were similar in the inhalational anaesthesia and TIVA groups but relatively higher in the spinal anaesthesia group. Blood glucose levels were elevated, insulin levels were decreased in all groups, at the intraoperative first hour. Biphasic variation in blood leptin levels was observed in all groups, as the levels were lower than the preoperative control values at the intraoperative first and postoperative third hours and significantly higher at the postoperative twenty-forth hour. There was a significant decrease in cortisol level percentage change in the TIVA group at the intraoperative 1st hour, increasing in the other groups.
  
  
  CONCLUSIONS
  We concluded that TIVA supresses the stress response induced by surgery better by lowering cortisol levels, leading to a lower increase in blood glucose levels and a lower decrease in blood insulin levels when compared to others. Furthermore, leptin levels were increased at the postoperative twenty-forth hour. The lower increase at the postoperative twenty-forth hour in the TIVA group can be correlated with the anaesthetic agent.
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Acar
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Ezgi Karakaş
authors.initials: EK
authors.lastname: Erkılıç
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Tülin
authors.initials: T
authors.lastname: Gümüş
authors.affiliation: Department of Medical Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Duygu
authors.initials: D
authors.lastname: Şahin
authors.affiliation: Department of Medical Biochemistry, Gazi University Faculty of Medicine, Ankara, Turkey.
authors.forename: Aylin Sepici
authors.initials: AS
authors.lastname: Dinçel
authors.affiliation: Clinic of Anaesthesiology and Reanimation, Ministry Health Atatürk Training and Research Hospital, Ankara, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Kanbak
keywords: Stress response of surgery; TIVA; inhalation anaesthesia; leptin; spinal anaesthesia