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Canadian Journal of Anesthesia, Vol 31, 509-516, Copyright © 1984 by Canadian Anesthesiologists' Society

Reports of Investigation: Hormonal and Haemodynamic Responses to Upper Abdominal Surgery during Isoflurane and Balanced Anaesthesia

SIMON GELMAN MD PHD1, JORGE E. RIVAS MD1, HAMDI ERDEMIR MD1, SUZANNE OPARIL MD1, JAMES PROCTOR 1, THOMAS MACKRELL MD1, and LLOYD SMITH MA1

1 Departments of Anesthesiology and Medicine, The University of Alabama Medical Center, Birmingham, Alabama

Address correspondence to: Dr. Simon Gelman, Department of Anesthesiology, The University of Alabama Medical Center, 619 South 19th Street, Birmingham, Alabama 35294.

The purpose of the study was to compare the protective role of different anaesthetic techniques against surgical stress. Sixty patients undergoing elective laparotomy were randomly divided into six groups of ten patients each: Group I was given 0.65 MAC nitrous oxide (66 per cent inspired) and 0.65 MAC isoflurane (0.75 per cent end-expired); Group II was given 0.65 MAC nitrous oxide and 1-1.2 MAC isoflurane (1.2-1.4 per cent end-expired); Group III was given the same anaesthetic management as patients in Group I but with the addition of fentanyl (2µg·kg-1) before the skin incision and 1/8 of the initial dose every 15 minutes during surgery; Group IV was treated as patients in Group I with an additional infusion of lidocaine (30µg·kg-1·min-1); Groups V and VI were given 0.65 MAC of nitrous oxide and fentanyl, 7.5 and 15 µg·kg-1, respectively, before skin incision with 1/8 of the initial dose every 15 minutes during the operation; diazepam, 5 mg IV each hour of surgery, was given to prevent intraoperative awareness. Cortisol concentration was determined by radioimmunoassay method and catecholamines were measured by high performance liquid gas chromatography in blood samples taken at different stages perioperatively.

All patients had satisfactory haemodynamic courses of anaesthesia. Statistically significant increases in both epinephrine and norepinephrine concentrations were observed during the immediate postoperative period in Group I patients only. Haemodynamic stability was maintained despite a two- to three-fold increase in cortisol which occurred during the operation and immediate postoperative period. More than I MAC of isoflurane in conjunction with nitrous oxide (Group II) andfentanyl in a loading dose of 15 µg·kg-1 (Group VI) did not show any advantages over other techniques employed, but substantially delayed awakening and extubation.

Key Words: ANAESTHETIC TECHNIQUES: balanced, inhalation • ANAESTHETICS VOLATILE: isoflurane • ANAESTHETICS, LOCAL: lidocaine • COMPLICATIONS: stress






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Copyright © 1984 by the Canadian Anesthesiologists' Society.