Effects of different anesthetic methods and anesthetic drugs on stress reaction during surgical operation

Abstract

To investigate the effect of four different anesthetic methods (combined epidural with general anesthesia with endotracheal intubation or with laryngeal mask airway, total intravenous anesthesia or remifentanil intravenous infusion combined with inhalational anesthesia) on stress reaction in patients undergoing upper abdominal surgery. Sixty ASAI-II patients, aged 18 - 65 y, scheduled for elective upper abdominal surgery were enrolled in the study. They were divided into four groups: epidural combine general anesthesia with intubation group (EG group) and with laryngeal mask group (EGL group), total intravenous remifentanil combined with propofol (RP group) and inhalational group (RI group). Blood pressure, ECG, SpO(2), PETCO(2) were monitored continuously. Level of epinephrine and norepinephrine, angiotensin I and angiotensin II, glicentin and blood glucose in blood plasma were measured before operation, after induction, after skin incision and at the end of operation. The Blood pressure in RP and RI groups was lower than that in EG and EGL groups at induction. Blood pressure and heart rate of EG group were higher than those in RP, RI and EGL groups during intubation. Heart rate of RP group changed least than the other groups at skin incision. Heart rate of EGL group was higher than that in the other groups at extubation. Epinephrine and norepinephrine were lowered slightly at intubation and skin incision, and were raised at the end of operation in all groups. Norepinephrine of RP group increased distinctly compared with preoperative level. Glicentin was decreased slightly at intubation in all groups, and dropped to the lowest at the end of operation, glicentin in RP group was decreased significantly compared with preoperative level. Blood glucose was lowered slightly at induction and intubation, and was raised distinctly at the end of operation in four groups. Glucagon and Blood glucose of RP and RI groups were lower than those of EG and EGL groups. Different anesthetic methods and anesthetic drugs had different effects on stress reaction (hormones) during surgical operation. Regardless of general anesthesia or intrathecal anesthesia, harmful stimulus could not be completely blocked by the intraoperative management and stress regulation during operation. Intrathecal anesthesia combined with general anesthesia could inhibit the stress reaction during upper abdominal surgery. Continuous remifentanil target controlled infusion could inhibit the degree of stress reaction, either.