The effects of anesthetic techniques on acute phase response at delivery (anesthesia and acute phase response)

Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients

Background

The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia.

Material/Methods

The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO₂). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4).

Results

Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO₂ values did not differ significantly between the groups (p=0.081).

Conclusions

Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.

Effect of surgeon experience on postoperative plasma cortisol and C-reactive protein concentrations after ovariohysterectomy in the dog: a randomised trial

OBJECTIVE

To determine if postoperative C-reactive protein (CRP) or cortisol concentrations were significantly changed between dogs undergoing ovariohysterectomy by an experienced or inexperienced surgeon. As part of the Charles Sturt University teaching program, 45 bitches from an animal shelter were surgically sterilised between March and October 2010.

METHODS

The dogs were randomly assigned to surgeons, with 37 sterilised by veterinary undergraduates and 8 by experienced surgeons. Blood samples were collected preoperatively and at 2, 4 and 6 h postoperatively. A standard midline ovariohysterectomy was performed and detailed records kept.

RESULTS

The median surgery time for experienced surgeons was 17 min versus 87 min for inexperienced surgeons. Anaesthesia time and blood loss were greater among the inexperienced surgeons. The CRP concentration increased significantly postoperatively for all animals (P < 0.001). Bitches sterilised by inexperienced surgeons had a significantly greater rise in CRP at 4 and 6 h post-surgery (P = 0.046). Serum cortisol concentrations were found to increase significantly over time for all animals (P < 0.001), but were not affected by surgeon experience.

CONCLUSION

The results suggest that inexperienced surgeons affect their patients differently to experienced surgeons, potentially through tissue trauma or anaesthetic duration. The lack of difference in the cortisol concentrations reflects the large number of triggers for cortisol release and, potentially, that there was little difference between the groups in terms of perceived pain in the presence of good analgesia. Serum CRP concentration may be a more sensitive measure than serum cortisol of differences in surgical trauma.

Similar effects of general and spinal anaesthesia on perioperative stress response in patients undergoing haemorrhoidectomy

Surgery induces release of neuroendocrine hormones (cortisol), cytokines (interleukin-6: IL-6, tumour necrosis factor-α: TNF-α), acute phase proteins (C-reactive protein: CRP, leptin). We studied the effects of general and spinal anaesthesia on stress response to haemorrhoidectomy. Patients were assigned to general and spinal anaesthesia groups (n = 7). Blood samples were drawn before induction and 24 hours after surgery. Perioperative levels of IL-6, TNF-α, CRP, cortisol, and leptin were comparable among the groups. Twenty four hours after surgery, TNF-α and cortisol did not change; IL-6 and CRP increased significantly in all patients. Significant increase in leptin levels was found in patients undergoing spinal anaesthesia. Except for the increase in leptin levels, there was no significant difference related to the effects of general and spinal anaesthesia.

Anaesthesia and the acute phase protein response in children undergoing circumcision

Concentrations of acute phase proteins (CRP: C-reactive protein, albumin) change during surgery. We investigated the acute phase response to circumcision and the effects of anaesthesia on this response. The children were divided into four groups; group 1 (intratracheal general anaesthesia, n=40), group 2 (general anaesthesia with mask, n=20), group 3 (ketamine, n=20), group 4 (local anaesthesia, n=35). Blood samples were obtained, 24 hours before circumcision, after premedication, and 24 hours after circumcision. CRP and albumin before circumcision were comparable for all groups. There was no increase in CRP, and albumin remained steady throughout the study. No difference was observed among the groups, and related to anaesthesia. No responsiveness may be explained with the size of injured tissue or anatomical and histological type of preputium.