The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery

Engquist, A.; Brandt, M. R.; Fernandes, A.; Kehlet, Henrik

doi:10.1097/00132586-197808000-00049

Cited by 12 publications

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“…In adults, a progressive increase in cortisol levels was also reported during the first six hours after surgery. 8 In the epidural group, a significant decrease in cortisel levels was observed at the end of surgery. This decrease suggests that adequate analgesia was obtained, and that afferent neurogenic impulses from the site of surgery were adequately blocked throughout the surgery.…”

Section: Discussionmentioning

confidence: 88%

Effect of lumbar epidural anaesthesia on plasma Cortisol levels in children

et al. 1988

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Section: Discussionmentioning

confidence: 88%

Effect of lumbar epidural anaesthesia on plasma Cortisol levels in children

et al. 1988

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“…Enquist ve ark. [36] Cerrahiye epidural analjezinin etkileri ile ilgili yaptıkları çalışmada, genel anestezi ile kombine olsun yada olmasın, nöral afferent iletiyi bloke eden epidural anestezinin, cerrahiye kortizol cevabının baskılanmasına yol açtığını göstermişlerdir [37].…”

Section: Discussionunclassified

Pre-emptif uygulanan intravenöz, spinal ve epidural morfinin erken postoperatif analjezi ve stres yanıt üzerine etkileri

Ayvaz¹,

Düğer²,

Gürsoy³

et al. 2013

CMJ

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ÖzetBu çalışmada, preemptif uygulanan iv, spinal ve epidural morfinin erken postoperatif dönemdeki analjezik tüketimi ve stres yanıt üzerine etkilerini belirlemek amaçlandı. Alt batın operasyonu uygulanacak ASA I-II grubuna giren 60 hasta rasgele üç gruba ayrıldı. Grup I'e indüksiyondan 5 dk. önce 5 mg iv morfin, Grup II'ye indüksiyondan 5 dk önce 0,5 mg intratekal morfin, Grup III'e indüksiyondan 30dk önce 5mg epidural morfin uygulandı. Anestezi indüksiyonu 0,1 µg kg -1 fentanil ve 4-7 mg kg -1 tiopental sodyum ile sağlandı. Kas gevşemesi ise 0,1mg/kg vekuronyum ile sağlandı. İdamede %1-2 sevofluran ve %50 N 2 O kullanıldı. Pre ve postoperatif dönemde hastaların hemodinamik parametreleri ve postoperatif dönemde hemodinamik parametreler, VAS (Visual Analog Ağrı Skala) değerleri, ilk analjezik ihtiyaç zamanları ve total analjezik tüketimi kaydedildi. Ayrıca stres yanıtı değerlendirmek için preoperatif dönemde ilaçlar uygulanmadan önce, peroperatif 30'uncu dakika ve postoperatif 2'nci saatte olmak üzere üç kan örneği alındı. Çalışmamızda VAS değerleri açısından postoperatif tüm zamanlarda iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı (P<0.05). İlk analjezik ihtiyaç zamanı ve total analjezik tüketimi açısından iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı bulundu (P<0.05). Prolaktin ve ACTH değerleri açısından perop. 30 dk. ve postop. 2'nci saatte iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı bulundu (P<0.05). Kortizol, glukoz ve insülin değerleri açısından postop; 2'nci saatte iv grup ile spinal grup ve iv grup ile epidural grup arasındaki farklılık anlamlı bulundu (P<0.05). Sonuç olarak preemptif uygulanan spinal ve epidural morfinin postoperatif ağrıyı gidermede ve stres yanıtı baskılamada iv gruba göre etkili oldukları tesbit edildi.Anahtar sözcükler: Preemptif analjezi, morfin, spinal analjezi, epidural analjezi, iv analjezi, stres yanıt AbstractIn this study, it was aimed to determine the effects of preemptive intravenous, spinal and epidural morphine on analgesic consumption, and stress response in the early postoperative period. Sixty ASA I-II patients who were undergoing lower abdominal surgery were randomly divided into three groups. Group I patients were admisnistered 5 mg iv morphine 5 minutes before induction, Grup II patients were administered 0.5 mg of intrathecal morphine 5 minutes before induction, Group III patients were administered 5 mg epidural morphine 30 min before induction of anesthesia. Induction of anesthesia, was performed with 0.1 mg kg -1 fentanyl and 4-7 mg kg -1 thiopental sodium. For muscle relaxation 0.1 mg kg -1 vecuronium were given. Anaesthesia was maintained with 1-2% sevoflurane and 50% N 2 O. Pre and postoperative hemodynamic parameters, VAS (Visual Analog Pain Scale) scores, time to first analgesic requirement, total analgesic consumption were recorded. In addition, to evaluate the stress response blood samples were taken three times before the administration of preope...

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“…Halothane per se induces myocardial depression and ganglionic blockade [14], but there have been reports on endogenic catecholamine release during general anaesthesia and surgical trauma, partly counteracting these effects [8]. Bahlman et al [4] have shown that nitrous oxide plus halothane produce less depression on myocardial function, cardiac output and mean arterial pressure in man, than does halothane alone at the same minimum alveolar concentration (MAC).…”

Section: Discussionmentioning

confidence: 99%

Central haemodynamics and regional blood flow during halothane-nitrous oxide anaesthesia and controlled ventilation

et al. 1983

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The haemodynamic effects of halothane-N2O/O2 anaesthesia with controlled ventilation were studied in rats, using the microsphere method. Mean arterial blood pressure was significantly reduced but only minor effects on cardiac output (CO), heart rate, and systemic vascular resistance were seen. During anaesthesia, there were significantly increased fractions of CO delivered to brain, lungs, small intestine and liver (hepatic artery), while the fractions to spleen, stomach and carcass were decreased. Fractional distribution and regional blood flow to heart, kidneys, adrenals and preportal area remained unchanged. When anaesthesia was prolonged from 60 to 90 min, no further changes in central or regional haemodynamics were seen. Considering the minor effects on central haemodynamics and the absence of changes in central and regional haemodynamics at 60 and 90 min, this anaesthesia model should be useful in experimental research.

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The Blocking Effect of Epidural Analgesia on the Adrenocortical and Hyperglycemic Responses to Surgery

Cited by 12 publications

References 0 publications

Effect of lumbar epidural anaesthesia on plasma Cortisol levels in children

Effect of lumbar epidural anaesthesia on plasma Cortisol levels in children

Pre-emptif uygulanan intravenöz, spinal ve epidural morfinin erken postoperatif analjezi ve stres yanıt üzerine etkileri

Central haemodynamics and regional blood flow during halothane-nitrous oxide anaesthesia and controlled ventilation

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