Comparison of serum dynamic thiol/disulphide homeostasis and nitric oxide levels of total intravenous vs inhaled anaesthesia in endoscopic transsphenoidal pituitary surgery

Abstract

Background Transsphenoidal pituitary surgery (TPS) is traditionally performed under general anaesthesia. This study aimed to compare the effects of total intravenous anaesthesia (TIVA) or sevoflurane, an inhalation anaesthetic, on thiol‐disulphide homeostasis in patients undergoing endoscopic endonasal TPS. Methods In this study, 84 patients scheduled for TPS were randomly categorised into two groups: propofol (n = 42, the TIVA group) or sevoflurane (n = 42, the SEVO group). Blood samples were taken before induction of general anaesthesia and at the 30 minutes of postoperation. Serum native thiol and total thiol levels were detected, and the number of dynamic disulphide bonds and related ratios were calculated from these values. Serum nitric oxide (NO) levels were measured using a chemiluminescence method. Results Although native thiol levels in TIVA postoperation group were markedly increased (P < .05), total thiol levels in SEVO postoperation group were significantly decreased (P < .01). Disulphide levels were declined in both groups (P < .05 for TIVA and P = .001 for SEVO groups). Disulphide/native thiol (P < .05 for both groups) and disulphide/total thiol ratios (P < .05 for TIVA and P < .01 for SEVO groups) were depressed in postoperation groups. We found a marked elevation in native thiol/total thiol ratio in both groups (P < .05 for TIVA and P < .01 for SEVO groups). There was significant augmentation in serum NO levels in the SEVO postoperation group (P < .05). Conclusion These results are the first to show that both TIVA and sevoflurane showed similar antioxidant effect with reduced disulphide levels, but sevoflurane may offer more robust oxidative stress protection and augmented NO production than TIVA during TPS. However, the clinical effect is needed to further investigate.

Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery

“…Controlled hypotension established via medications such as nitroglycerin, nitroprusside, or esmolol, has also been extensively evaluated within the realm of ESS visualization, with no available evidence in TSA cohorts 61–63. Additional studies have investigated the effect of TIVA on temperature regulation, markers of oxidative stress, respiratory function, and neuroendocrine functional outcomes 64–67. Within this growing body of evidence multiple RCTs and systematic reviews focusing on ESS patients have demonstrated reductions in bleeding and improved surgical field visibility using TIVA relative to inhaled anesthetics 57–59.…”

“…[61][62][63] Additional studies have investigated the effect of TIVA on temperature regulation, markers of oxidative stress, respiratory function, and neuroendocrine functional outcomes. [64][65][66][67] Within this growing body of evidence multiple RCTs and systematic reviews focusing on ESS patients have demonstrated reductions in bleeding and improved surgical field visibility using TIVA relative to inhaled anesthetics. [57][58][59] Such improvements in surgical visualization must be weighed against the necessity of maintaining sufficient MAP for adequate coronary and cerebral blood flow during TSA.…”

El estrés oxidativo en el perioperatorio: implicaciones clínicas

“…La anestesia con bajo flujo y sevoflurano no crea ninguna diferencia en los parámetros hemodinámicos, por lo tanto, se puede usar con seguridad (23) . Por otro lado, en el postoperatorio de cirugía cardíaca y no cardíaca, diversos estudios han demostrado resultados promisorios del manejo anestésico preventivo del EOx (24)(25)(26) . Para esto hay que considerar los efectos específicos oxidantes y antioxidantes de los agentes anestésicos (2,27,28) .…”