期刊
JOURNAL OF CLINICAL ANESTHESIA
卷 22, 期 4, 页码 250-255出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinane.2009.07.011
关键词
Laparoscopy; Neuroendocrine stress response; Propofol; Remifentanil; Sevoflurane; Total intravenous anesthesia
Study Objective: To compare intraoperative and postoperative neuroendocrine stress responses during total intravenous anesthesia (TIVA) using propofol and remifentanil versus sevoflurane anesthesia, during laparoscopic surgery. Design: Prospective, randomized study. Setting: Tertiary-care university hospital. Patients: 46 ASA physical status I patients undergoing laparoscopic surgery for benign ovarian cysts. Intervention: Patients were randomly allocated to two groups to receive either TIVA (Group A = 23) or sevoflurane anesthesia (Group B = 23). Measurements: Perioperative plasma levels of norepinephrine (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), prolactin (PRL), and thyroid hormones (TSH, FT3, FT4) were measured. Blood samples were collected preoperatively, 30 minutes after the beginning of surgery, after extubation, and two and 4 hours after the end of surgery (times 0, 1, 2, 3, and 4). Main Results: In Group A, perioperative levels of NE, E, ACTH, cortisol, and GH compared with preoperative values significantly decreased; in Group B they increased (Groups A vs. B: time 1, P < 0.001 for all markers; time 2, P < 0.001 for E, ACTH, cortisol, and GH; time 3, P < 0.01 for cortisol, NE, and E, and P < 0.05 for ACTH and GH). Perioperative PRL levels were significantly enhanced in both groups versus preoperative values. In both groups, TSH levels increased while FT3 levels decreased significantly relative to basal values. In both groups, perioperative FT4 levels significantly increased compared with preoperative values.
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