Influence of components of anesthesia on dynamics of stress markers in gynecological laparoscopic surgery.
DOI:
https://doi.org/10.26641/2307-0404.2019.3.181876Keywords:
cortisol, glycemia, ketamine, dexketoprofen, postoperative painAbstract
Surgical procedures are associated with a complexity of stress response characterized by neurohumoral, immulogic, and metabolic alterations. Objective: to evaluate the effect of combined intraoperative use of ketamine in low subnarcotic doses and dexketoprofen on intensity of the pain syndrome and dynamics of the stress response in gynecological laparoscopic surgery. A total of 45 patients scheduled for laparoscopic gynecological surgery under total intravenous anesthesia (TIA) were examined randomly and divided into 2 groups. Demographic characteristics, anthropometric data, functional status, duration of surgery and anesthesia were similar in all groups. Group 1 (n=25) patients received total intravenous anesthesia (TIVA) with propofol and fentanyl. Group 2 (n=20) patients received TIVA with additional administration of subanesthetic doses of ketamine and a single administration of 50 mg of dexketoprofen 30 minutes before the end of the surgery. Cortisol and blood glucose levels were evaluated before induction into anesthesia, after the main stage of operation, 2 and 24 hours after surgery. The intensity of postoperative pain was evaluated by VAS in 2 and 24 hours after surgery. The intensity of postoperative pain, concentration of serum cortisol 2 hours after surgery were significantly lower (p <0.05) in patients of group 2, compared to control (p<0,05). Differences of blood glucose levels between groups at the stages of the study were not identified. Combined intraoperative use of subanesthetic doses of ketamine and dexketoprofen at the end of the surgery provides a stress-protective effect. This is confirmed by the rapid normalization of serum cortisol levels and stable blood glucose levels after surgery and is manifested by a low level of postoperative pain syndrome.References
Shaikh S, Verma H, Yadav N, Jauhari M, Bullangowda J. Applications of steroid in clinical practice: a review. ISRN Anesthesiol. 2012;2012:985495. doi: https://doi.org/10.5402/2012/985495
Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Stamos MJ, et al. A nationwide analysis of the use and outcomes of epidural analgesia in open colorectal surgery. J Gastrointest Surg. 2013;17(6):1130-7. doi: https://doi.org/10.1007/s11605-013-2195-4
Colloca L, Benedetti F. Nocebo hyperalgesia: how anxiety is turned into pain. Curr Opin Anaesthesiol. 2007;20(5):435-9. doi: https://doi.org/10.1097/aco.0b013e3282b972fb
Jovanovski-Srceva M, Kuzmanovska B, Mojsova M, Kartalov A, Shosholcheva M, Temelkovska-Stevanoska M, et al. Insulin resistance, glycemia and cortisol levels in surgical patients who had preoperative caloric load with amino acids. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2015;36(3):61-70. doi: https://doi.org/10.1515/prilozi-2015-0079
Widnyana IMG, Senapathi TGA, Aryabiantara IW, Wiryana M, Sinardja K, Budiarta IG, et al. Metabolic stress response attenuate by oral glucose preoperatively in patient underwent major surgery with general anesthesia. Int J Anesth Pain Med. 2017;3:1. doi: https://doi.org/10.21767/2471-982x.100015
Nau C. [From preemptive to preventive analgesia]. Anaesthesist. 2013;62(10):787-8. German. doi: 10.1007/s00101-013-2250-2.
Johansen A1, Romundstad L, Nielsen CS, Schirmer H, Stubhaug A. Persistent postsurgical pain in a general population: prevalence and predictors in the Tromso study. Pain. 2012;153(7):1390-6. doi: https://doi.org/10.1016/j.pain.2012.02.018
Venkata Ramudu R, Giridhar T, Mahendra T, Goutham RK, Rohith R. Relationship between surgical stress and serum cortisol level: a comparative study among elective and emergecive surgery. IAJPR. 2015;5(12):3759-3764.
Velickovic I, Yan J, Grass JA. Modifying the neuroendocrine stress response. Semin Anesth Perioper Med. Pain. 2002;21(1):16-25. doi: https://doi.org/10.1053/sane.2002.30675" target="_blank">https://doi.org/10.1053/sane.2002.30675
Radvansky BM, Shah K, Parikh A, Sifonios AN, Le V, Eloy JD. Role of ketamine in acute postoperative pain management: a narrative review. Biomed Res Int. 2015;2015:749837. doi: http://dx.doi.org/10.1155/2015/749837
Kahveci K, Ornek D, Doger C, Aydin GB, Aksoy M, Emre C, et al. The effect of anesthesia type on stress hormone response: comparison of general versus epidural anesthesia. Niger J Clin Pract. 2014;17(4):523-7. doi: https://doi.org/10.4103/1119-3077.134058
Abdelmalak BB, Bonilla AM, Yang D, Chowdary HT, Gottlieb A, Lyden SP, et al. The hyperglycemic response to major noncardiac surgery and the added effect of steroid administration in patients with and without diabetes. Anesth Analg. 2013;116(5):1116-22. doi: https://doi.org/10.1213/ane.0b013e318288416d
Finnerty CC, Mabvuure NT, Ali A, Kozar RA, Herndon DN. The surgically induced stress response. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):21S-9S. doi: https://doi.org/10.1177/0148607113496117
Ulrich-Lai YM, Herman JP. Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci. 2009;10(6):397-409. doi: https://doi.org/10.1038/nrn2647
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