Comparison of Stress Hormone Response, Interleukin-6 and Anaesthetic Characteristics of Two Anaesthetic Techniques: Volatile Induction and Maintenance of Anaesthesia using Sevoflurane versus Total Intravenous Anaesthesia using Propofol and Remifentanil

Abstract

This prospective randomized study compared the effects of two types of anaesthesia on peri-operative anaesthetic profiles from induction to recovery and on immunological and neurohormonal responses to anaesthesia and surgical stress. Forty patients were assigned to undergo either volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane or total intravenous anaesthesia (TIVA) with propofol and remifentanil. Plasma adrenaline, noradrenaline, cortisol, glucose and interleukin-6 (IL-6) levels were measured at baseline, induction, incision and extubation. TIVA produced a significantly lower intubation score, shorter time to intubation and faster waking time than VIMA, but recovery profiles did not differ. Adrenaline, noradrenaline, cortisol and glucose levels were significantly lower with TIVA than VIMA, but there was no difference in IL-6 levels between the two groups.TIVA with propofol and remifentanil may be preferable to VIMA with sevoflurane alone because it leads to smoother, more rapid induction, more rapid awakening and lower stress responses to surgical stimuli.

Evaluation of Stress Response and Apoptosis on Leucocytes in TIVA versus Balanced Anesthesia

“…Unlike our results, Ihn et al [12] detected higher level of epinephrine, norepinephrine, cortisol and glucose in the inhalation group compared to TIVA group, which reveals a better control of metabolic response using intravenous drugs.…”

Total Intravenous Versus Inhalation Anesthesia in Patients Undergoing Laparoscopic Cholecystectomies. Effects on Two Proinflammatory Cytokines Serum Levels: Il-32 and TNF-Alfa.

“…It has been demonstrated that the total intravenous anesthesia using propofol and remifentanil suppresses the inflammatory response caused by surgery, to a greater extent than a balanced inhalation technique [9]. Ihn et al concluded that there are still controversies about which anesthetic technique best suppresses the inflammatory and immunological responses.…”

The Cortisol to Cortisone Ratio during Cardiac Catheterisation in Sows

“…sevoflurane, isoflurane, enflurane, etc. and an opioid) (Schricker et al, 2000;Ledowski et al, 2005;Ihn et al, 2009;Kostopanagiotou et al, 2010;Marana et al, 2010). TIVA, consisting of a combination of propofol and morphine, was used in our experiment (for details see in section "Anaesthesia and medication").…”

“…It improves decreased sympathetic activity alpha and beta adrenergic receptors (Krzych et al, 2009). Combination of propofol and morphine (or other opioid) decreasing catecholamines and glucocorticoid released to blood (Fragen et al, 1987;Schricker et al, 1999Schricker et al, , 2000Ihn et al, 2009). The propofol/opioid combination suppresses HPA activity at each level.…”