The differential impact of volatile and intravenous anaesthetics on stress response in the swine

Abstract

OBjEcTIVE: To compare the effects of various anaesthetics on stress response in the presence and absence of surgical stimulation. DESIGN: Twenty-nine pigs scheduled to undergo surgical central vein catheter placement were randomly allocated to receive only sedation with ketamine-midazolam (group SHAM, n=5) or general anaesthesia with either propofol 8 mg/kg/h (group PROP, n=8), sevoflurane 1.0 MAc (group SEVO, n=8) or desflurane 1.0 MAc (group DESF, n=8). Following surgery, anaesthesia was maintained for a total period of 4 hours. Thyroid hormones, noradrenaline, cortisol, corticotrophin (AcTH), β-endorphin, interleukin-1β and -6 and tumor necrosis factor-α were determined by appropriate methodology after premedication (t0), after surgical procedure (t1) and at the end of 4h (t2). RESULTS: At t1 AcTH and β-endorphin increased in all groups, thyroxin in groups SEVO, DESF and PROP, noradrenaline in group SEVO and cortisol in the SHAM and PROP groups. At t2 cortisol and AcTH levels were lower in the PROP compared to SEVO group. Serum cytokines were not significantly altered in either group. cONcLUSIONS: The choice of the general anaesthetic did not affect thyroid hormones levels in either the presence or absence of surgical stimulus. In the presence of surgical stimulation, sevoflurane resulted in higher noradrenaline levels and in higher activity of the AcTH-cortisol axis compared to propofol.

The differential impact of volatile and intravenous anaesthetics in humans

“…1 We would like to highlight earlier human data of ours (some of which unpublished to date) as well as from others that are pertinent to this interesting line of research and generally supportive of the authors' conclusions.…”

The Effects of Desflurane and Propofol on the Release of Thyroid Hormones in Euthyroid Patients Undergoing Elective Lumbar Discectomy

“…It was previously demonstrated that inhalational anaesthetic agents do not affect the plasma levels of TSH (17,18). Nevertheless, an opposite result was obtained in our study: plasma TSH levels reached their peak levels at the first hour postoperatively in both Groups P and D. The answer may be hidden in the use of remifentanil infusion.…”

“…If not, general anaesthesia will have to be provided in hypo-or hyperthyroid states. Under these circumstances, it is obligatory to administer an appropriate anaesthetic agent that has minimal effects on thyroid hormone levels in order to protect the patient from unwanted side effects of thyroid disease (8). Many studies investigated the effects of the type of anaesthesia and anaesthetic agents on thyroid hormone levels, but few reports focused on the effects of desflurane on thyroid functions (1,9).…”

Airway Deposition of Nebulized Gene Delivery Nanocomplexes Monitored by Radioimaging Agents

“…Therefore, only the distal portion of the trachea, the lining among the apical lobes of the lungs, and the area proximal to the primary bronchi were included in the quantification of radioactivity. Moreover, ketamine, although providing mild anesthesia with relatively normal breathing capability (43,44), causes an increased production of mucus and saliva (45,46), which may have promoted the mucociliary clearance of either the nanocomplexes or the Tc-99m RTNs from the trachea. Although atropine should counteract this effect (47), the amount used might not have been sufficient.…”