Comparisons of different methods of anesthesia and analgesia on the levels of glycometabolism rate-limiting enzymes in erythrocytes and plasma glucose and stress hormones in patients undergoing esophagus surgery

Abstract

Objective To compare the effects of different methods of anesthesia and analgesia on the activities of phosphofructokinase(PFK), glucose-6-phosphate dehydrogenase(G-6PD) and aldose reductase(AR) in erythrocytes and levels of plasma glucose and stress hormones in patients undergoing esophagus surgery. Methods Sixty-two patients scheduled for esophagus surgery were randomly divided into three groups: group I( n = 20) receiving only general anesthesia(GA) followed by intravenous patient controlled analgesia(PCA) with fentanyl 15μg/kg. The other two groups receiving both general anesthesia combined with thoracic epidural anesthesia (GEA) and either intravenous PCA with fentanyl 15μg/kg (group II, n = 21) or thoracic epidural analgesia(TEA) with 0.125% ropivacaine and 0.0002% fentanyl mixture(group III, n = 21) after the operation. Venous blood samples were collected for measurements of PFK, G-6PD and AR activities in erythrocytes and plasma glucose, cortisol, epinephrine and norepinephrine before induction (T 1), 60 min following the incision (T 2), 60 min(T 3) after operation, on the 1st(T 4) and 2nd postoperative day(T 5). Results The activities of PFK decreased( P < 0.01 or P = 0.004) and the activities of G-6PD and AR increased( P < 0. 01) in groups I and II on T 4 compared with those on T 1. Between the two groups, the activities of these enzymes in group II changed less than those of group I( P < 0.01 or P < 0.05). These enzymes activities changed slightly in group III on T 4( P > 0.05). There were significant differences between group III and the other two groups( P < 0.01 or P < 0.05). The levels of plasma glucose increased significantly on T 2( P < 0.01), reached peak values on T 4( P < 0.01) and fell on T 5 in the three groups. Compared to those of groups I and II, the values of plasma glucose in group III were lower on T 4 and T 5( P < 0.05 or P < 0.01). The cortisol concentration in each group increased significantly at T 2( P < 0.01 or P < 0.05), and remained elevated on T 5( P < 0.01 or P < 0.05), while on T 2 and T 3 the cortisol levels of group'were higher than that of groups II and III ( P < 0.05). The levels of group III were lower than those of the other groups on T 4 and T 5( P < 0.01 or P < 0.05). The levels of epinephrine and norepinephrine were also significantly higher in group I than those of the other two groups on T 2( P < 0.01 or P < 0.05), and their levels in group I and II were higher than that of group III on T 4. The patients of the three groups obtained satisfactory pain relief, with all Vidual Analogue Scale(VAS) scores less than 3. VAS scores of group I were much greater 4h after operation. Group III VAS scores were the lowest 24h after operation. However, the number of times patients pressed the bolus switch was higher in group II ( P < 0.01). Conclusion Compared with GA and intravenous PCA, general anesthesia combined with thoracic epidural anesthesia and analgesia obtain better pain relief and could markedly alleviate the stress response and improve these erythrocyte glucose metabolism changes after esophagus surgery.