The effects of deep and light propofol anesthesia on stress response in patients undergoing open lung surgery: a randomized controlled trial

Abstract

BackgroundThis prospective, randomized controlled study was undertaken to compare stress hormone response to open thoracotomy for lung resection at different anesthetic depths, as determined by bispectral index (BIS) monitoring, in patients under propofol-remifentanil anesthesia.MethodsForty-eight adult patients scheduled for lung resection surgery using one-lung ventilation were randomly assigned to either a deep anesthesia group (BIS score of 40 ± 5, n = 24) or a light anesthesia group (BIS score of 60 ± 5, n = 24) by adjusting propofol infusion rates. Blood norepinephrine, epinephrine, adrenocorticotropic hormone, and cortisol levels were measured before the induction of anesthesia, at the end of surgery, and at 2 hours postoperatively. Blood glucose, hemodynamic, and oxygenation-ventilation variables, and postoperative outcomes were also measured.ResultsNorepinephrine and epinephrine levels remained unchanged over time in the deep group, but norepinephrine levels significantly increased in the light group at 2 h after surgery than at baseline (P = 0.007 and 0.004, respectively). Temporal changes in norepinephrine, but not in epinephrine, were significantly different between the two groups (P = 0.036). Plasma glucose levels in the light group increased with time and were significantly higher than in the deep group at the end of surgery (P = 0.002).ConclusionsA deep level of anesthesia achieved using high propofol infusion rates during lung surgery provided lower perioperative norepinephrine and glucose responses than light level of anesthesia during the early postoperative period but failed to affect immediate postoperative outcomes.

Renal perfusion, oxygenation, and sympathetic nerve activity during volatile or intravenous general anaesthesia in sheep

“…Evidence for different effects of anaesthetics on total sympathetic activity in humans is demonstrated by increases in plasma noradrenaline with isoflurane, but not with propofol. 34,35 Our findings support the notion that propofol, which does not induce increases in intraoperative RSNA, maybe less injurious to the kidney during surgery than volatile anaesthesia. In this regard, a lower incidence and severity of postoperative AKI after valvular heart surgery 36 has been reported with surgical procedures conducted with propofol than with sevoflurane anaesthesia.…”

Salivary cortisol levels and anxiety in melanoma patients undergoing sentinel lymph node excision under local anesthesia versus general anesthesia: a prospective study

“…It is known to abolish cortisol secretion in cardiac surgery [25]. Accordingly, propofol in higher doses averts secretion of cortisol during surgery as well [26]. From these observations follow that medically induced suppression of corticosteroid secretion might oppose physiological rise in cortisol level.…”

Post-operative insulin resistance

“…Применение дек-смедетомидина продемонстрировало лучший контроль гликемии в послеоперационном периоде при сравне-нии с анестезией на основе фентанила и рекомендуется для использования у пациентов с СД и нарушением то-лерантности к глюкозе [53,54]. В исследовании Gupta K. и соавт.…”

“…и соавт. в 2105 г. отметили значимое сни-жение частоты и уровня послеоперационной гипергли-кемии (р=0,002) у пациентов в торакальной хирургии при проведении тотальной внутривенной анестезии с применением пропофола и ремифентанила для дости-жения большей глубины анестезии по данным монито-ринга центральной нервной системы (BIS 60±5 vs 40±5, р=0,002), что, по мнению авторов, вызвано меньшим вы-бросом норадреналина и лучшей коррекцией операцион-ного стресса [54].…”