Propofol Requirement in Patients with Growth Hormone-Secreting Pituitary Tumors Undergoing Transsphenoidal Surgery

Abstract

Growth hormone (GH) secretion is regulated by various hormones or neurotransmitters, including gamma-aminobutyric acid. The aim of this study was to determine the propofol requirement in patients with GH-secreting pituitary tumors undergoing transsphenoidal surgery. General anesthesia was induced in 60 patients with GH-secreting tumors (GH group, n = 30) or nonfunctioning pituitary tumors (NF group, n = 30) using an effect-site target-controlled intravenous propofol infusion. The effect-site concentrations were recorded at both a loss of consciousness and a bispectral index (BIS) of 40, along with the effect-site concentration after extubation, during emergence from the anesthesia. The effect-site concentration of propofol was higher in the GH group than in the NF group at a loss of consciousness and a BIS of 40 (4.09 ± 0.81 vs. 3.58 ± 0.67, p = 0.009 and 6.23 ± 1.29 vs. 5.50 ± 1.13, p = 0.025, respectively) and immediately after extubation (1.60 ± 0.27 vs. 1.40 ± 0.41, p = 0.046). The total doses of propofol and remifentanil during anesthesia were comparable between the groups (127.56 ± 29.25 vs. 108.64 ± 43.16 µg/kg/min, p = 0.052 and 6.67 ± 2.89 vs. 7.05 ± 1.96 µg/kg/h, p = 0.550, respectively). The propofol requirement for the induction of a loss of consciousness and the achievement of a BIS of 40 is increased during the induction of general anesthesia in patients with GH-secreting tumors.

Beneficial Effects of Low-Dose Intravenous Dexmedetomidine Premedication in Patient Undergoing Laparoscopic Cholecystectomy Under General Anesthesia: A Prospective, Double-Blind, Randomized Controlled Trial

“…Propofol induces sedation by potentiating the activity of γ-aminobutyric acid (GABA) receptors. 17,18 The catecholamine release in the preoptic area of the hypothalamus is decreased by Dex, disinhibiting the GABAergic inhibitory projections to the major arousal nuclei in the midbrain and pons and reducing noradrenergic signaling in the hypothalamus and cortex, thereby inhibiting sympathetic nerve activity and achieving a sedative effect. 19 Furthermore, Dex induces analgesia by blocking the transmission of pain signals in the descending medullary-spinal noradrenergic pathway and prevents relaying of the peripheral stimuli.…”

Evaluation of autoantibody signatures in pituitary adenoma patients using human proteome arrays

“…GABA regulates GH synthesis via GABA‐B receptors in pituitary and rat GH3 adenoma cells [85]. Several studies show that GABA could play a physiological role in controlling hormone secretion such as GH, LH and PRL from the anterior pituitary, via pituitary‐hypothalamic action [86, 87]. Proteins DPP3, RTN4, KLHDC4, SRRT and CAMKK1 were further mapped with tissue RNA expression of neuroendocrine glands and brain subregions (Table 6 and Figure 4A).…”