FENTANYL AND THE Β-Endorphin, ACTH AND GLUCOREGULATORY HORMONAL RESPONSE TO SURGERY

Lacoumenta, S.; Paterson, Jennifer; Hall, George; Yeo, T. H.; Burrin, J. M.; Bloom, S.R.

doi:10.1093/bja/59.6.713

Cited by 41 publications

(26 citation statements)

References 8 publications

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“…We showed in a previous study that the rise in circulating adrenaline and noradrenaline concentrations with eye surgery under general anaesthesia is much less than that found in upper abdominal and pelvic surgery [23]. Lactic acidaemia may be an indirect indication of increased sympathetic activity [24], and the lack of this response in our study also indicates only modest activation of the sympathoadrenal system.…”

Section: Resultscontrasting

confidence: 48%

The metabolic and hormonal response to cataract surgery

Barker

Vafidis²,

Robinson

et al. 1993

Anaesthesia

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SummaryWe studied the metabolic and hormonal responses of 30 elderly patients undergoing routine cataract surgery who were allocated randomly to receive either general anaesthesia, or local anaesthesia by means of either retrobulbar or peribulbar blockade. Both jorms of local anaesthesia successfuIly prevented the increases in circulating cortisol and glucose concentrations seen in those patients who received general anaesthesia, there being no significant diflerences between retrobulbar and peribulbar blockade. The results show 'that the newer, and now more commonly performed peribulbar block, confers the same metabolic and hormonal stability as seen with the more traditional retrobulbar block. Key wordsAnaesthetic techniques, regional; retrobulbar, peribulbar. Hormones; cortisol. Surgery; ophthalmological.We showed in a previous study that local anaesthesia given by retrobulbar blockade inhibited the endocrine, and markedly reduced the metabolic, changes occurring in patients undergoing cataract surgery with general anaesthesia [I]. Today, retrobulbar block is less commonly performed, as peribulbar blockade is becoming the technique of choice. In peribulbar blockade a larger volume of local anaesthetic is injected around the orbit of the eye at one or two injection sites, whereas in retrobulbar block a smaller volume is injected intraconally towards the ciliary ganglion [2]. Although it may take slightly longer for effect, the peribulbar block has been shown to be as effective as retrobulbar block in providing sensory blockade and akinesia [3] while serious side effects are reduced as the needle is further from the dura and major blood vessels. The object of the present study was to determine whether peribulbar block, with its anaesthetic solution placed more peripherally, is as effective as retrobulbar block in decreasing the metabolic and hormonal changes associated with cataract surgery when performed under general anaesthesia. MethodsWe studied 30 elderly patients admitted for cataract surgery. They were suitable for either general or local anaesthesia and were otherwise healthy and not receiving any medication known to interfere with the hormonal and metabolic response to surgery. The patients were allocated randomly to receive either general anaesthesia (GA), local anaesthesia by retrobulbar blockade (RB), or local anaesthesia by peribulbar blockade (PB). The nature of the study was explained to them and informed consent obtained. The study was approved by the hospital ethics committee.No premedication was given to the patients. On arrival in the anaesthetic room, a central venous catheter was introduced percutaneously through an antecubital fossa vein for collection of blood samples. A control blood sample was collected after a 10 min rest period. In the GA group, anaesthesia was induced with a sleep dose of thiopentone, the trachea intubated after the administration of vecuronium and the lungs ventilated with N,O-0, and enflurane 0.6-1 .O%. Ventilation was adjusted to maintain an end-tidal CO, tension ...

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Section: Resultscontrasting

confidence: 48%

The metabolic and hormonal response to cataract surgery

Barker

Vafidis²,

Robinson

et al. 1993

Anaesthesia

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“…It is interesting that there were no statistically significant differences between the sexes because women reported significantly higher anxiety on STAI-State at all three times in this study. p -Cortisol values after termination of bronchoscopy could be confounded because all patients received midazolam and most were also sedated with fentanyl, both of which appear to have an impact on p -cortisol levels (36–38). …”

Section: Discussionmentioning

confidence: 99%

Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy: a randomised controlled trial

Jeppesen

Pedersen

Larsen

et al. 2016

European Clinical Respiratory Journal

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BackgroundThe use of music to relieve anxiety has been examined in various studies, but the results are inconclusive.MethodsFrom April to October 2015, 160 patients undergoing examination of pulmonary nodules were randomly assigned to MusiCure or no music. MusiCure was administered through earplugs to ensure blinding of the staff and was played from admission to the operating theatre to the end of the bronchoscopy. Spielberger’s State-Trait Anxiety Inventory (STAI) was administered on admission, immediately before bronchoscopy, and on discharge. Secondary outcomes were p-cortisol, physiological variables, dosage of sedatives, movements measured by Actigraph, bronchoscopy duration, number of re-examinations, and overall perception of the sounds in the operating theatre measured by Visual analogue scale.ResultsThe STAI scores were similar on admission, but after a 10-min wait in the operating theatre, scores varied significantly between patients with and without music, with lower scores in the music group [median (interquartile range, IQR) 35 (18) vs. 43 (25); p=0.03]. Post hoc multiple regression revealed treatment group as insignificant when adjusting for sex and baseline anxiety. However, there was a significantly more positive perception of the sounds in the operating theatre in the music group (median (IQR) 8.2 (1.8) vs. 5.4 (6.8); p<0.0001) and fewer re-examinations in the music group (19.2% vs. 7.7%, p<0.032).ConclusionsTen minutes with MusiCure does not alter anxiety when adjusting for baseline anxiety and sex. The current study indicates that this field of research has many confounders.

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“…Although adequate anaesthesia relieves the patient of pain, their body experiences a cascade of neuroendocrine reactions [7], mostly related to sympathetic activation of the autonomous nervous system [8]. Opioid administration exerts analgetic function through complex interactions with their receptors, which dampen sympathetic response to pain, in the setting of pharmacologically reduced consciousness [9].…”

Section: Discussionmentioning

confidence: 99%

Porównanie wpływu indukcji znieczulenia ogólnego, opartej na małej dawce opioidu, z wykorzystaniem deksmedetomidyny i indukcji znieczulenia ze standardową dawką opioidu na reakcję wywołaną intubacją tchawicy u osób otyłych

Gaszyński¹,

Czarnik

Łaziński

et al. 2016

Anaesthesiol Intensive Ther

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Background: Anaesthesiologists are facing the problem of an increasing population of morbidly obese patients. In order to minimize the risk of opioid-induced postoperative respiratory failure, the intraoperative administration of opioids should be reduced or replaced with other drugs. The purpose of this study was to compare haemodynamic response elicited by intubation in morbidly obese patients between two variants of anaesthesia induction: fentanylbased or low-opioid using dexmedetomidine. Methods: Forty-two morbidly obese patients scheduled for bariatric surgery were randomly assigned to two groups: low-opioid using dexmedetomidine (DEX) or fentanyl-based (FNT) anaesthesia. Patients were premedicated with 100 µg of fentanyl i.v. In the DEX group, a 10 minute infusion of a loading dose of 200 µg of dexmedetomidine was started. In the FNT group, 2 mg of intravenous midazolam was given. Thereafter, propofol was used in both groups. In the FNT group, patients received a dose of fentanyl up to 5 µg kg -1 of ideal body weight. Following administration of rocuronium, laryngoscopy and tracheal intubation were performed. Haemodynamic parameters, including systolic (SBP), diastolic (DBP) and mean arterial (MAP) blood pressure, as well as heart rate (HR), were recorded before and after intubation. Patients who were not intubated at first attempt were excluded from the study. Results: Data from 33 patients were analysed. There were no statistically significant differences between the DEX and FNT groups regarding demographic data. Haemodynamic response to intubation was defined as mean change (d) in values of analysed parameters that occurred during intubation. The following differences were observed: dSBP FNT +11.6 mm Hg vs. DEX +0.4 mm Hg (P = 0.15); dDBP FNT +3.7 mm Hg vs. DEX +3.5 mm Hg (P = 0.98); dMAP FNT +8.6 mm Hg vs. DEX +1.4 mm Hg (P = 0.36); dHR FNT +2 beats min -1 vs. DEX −1 beat min -1 (P = 0.30). None of these comparisons yielded significant differences. Conclusions: The study revealed no advantage of fentanyl over low opioid dexmedetomidine-based induction of general anaesthesia in attenuating cardiovascular response to intubation in morbidly obese patients.

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FENTANYL AND THE Β-Endorphin, ACTH AND GLUCOREGULATORY HORMONAL RESPONSE TO SURGERY

Cited by 41 publications

References 8 publications

The metabolic and hormonal response to cataract surgery

The metabolic and hormonal response to cataract surgery

Music does not alter anxiety in patients with suspected lung cancer undergoing bronchoscopy: a randomised controlled trial

Porównanie wpływu indukcji znieczulenia ogólnego, opartej na małej dawce opioidu, z wykorzystaniem deksmedetomidyny i indukcji znieczulenia ze standardową dawką opioidu na reakcję wywołaną intubacją tchawicy u osób otyłych

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