Comparison of hemodynamic and neuroendocrine changes during total intravenous anesthesia and inhalation anesthesia

Abstract

Background: Various aspects of anesthesia and surgery cause stress-induced endocrine and metabolic changes in organisms due to stimulation of the sympathoadrenergic system. Intravenous and inhalation anesthetic agents alter endocrine and metabolic responses to surgical stimuli. Objective: The objective of this study was to compare the effects of 2 anesthesia methods on patient response to surgical stress. Three components of general anesthesia were involved: hypnosis, analgesia, and muscle relaxation. Methods: Patients were randomly assigned to 1 of 3 groups: Group I received total intravenous anesthesia (TIVA) using propofol and alfentanil. Group II received inhalation anesthesia and was divided into 2 subgroups: group IIA received isoflurane, and group IIB received sevoflurane. Patients from all 3 groups underwent assessment of hemodynamic variables (heart rate, systolic blood pressure [SBP], and diastolic blood pressure [DBP]) and endocrinologic variables (plasma levels of blood glucose, C peptide, insulin, catecholamines [epinephrine, norepinephrine], and cortisol). Results: Sixty patients were enrolled in the study and assigned to 1 of the 3 groups (20 per group). Heart rate decreased significantly ( P < 0.05) after induction and remained lower than the preinduction value throughout surgery in the TIVA group. Significant increases in heart rate occurred in both inhalation anesthesia groups: after intubation ( P < 0.01) and after extubation ( P < 0.05) in the isoflurane group; after induction, intubation, and extubation ( P < 0.05) in the sevoflurane group. SBP decreased significantly in the TIVA group ( P < 0.01 after induction and P < 0.05 thereafter); significant increases ( P < 0.05) were seen after intubation and after extubation in both inhalation anesthesia groups. DBP decreased ( P < 0.05) after intubation in the TIVA group and increased in the isoflurane group ( P < 0.01 after intubation and incision, P < 0.05 after extubation). At the first intraoperative hour, significant increases compared with preinduction values ( P < 0.05) were observed in C peptide and insulin levels in the TIVA group, epinephrine in the isoflurane group, and blood glucose and norepinephrine in both inhalation anesthesia groups. Significant decreases ( P < 0.05) were found in C peptide and insulin levels in the 2 inhalation anesthesia groups. Measurements taken at the second postoperative hour and compared with preinduction values revealed significant increases ( P < 0.05) in C peptide in all groups, norepinephrine in the TIVA group, and insulin and cortisol in the 2 inhalation anesthesia groups. Conclusions: Based on our results, we concluded that hemodynamic and neuroendocrine responses to surgical stress are better controlled with TIVA compared with inhalation anesthesia.