Neuroendocrine Stress Response and Heart Rate Variability: A Comparison of Total Intravenous Versus Balanced Anesthesia

Ledowski, Thomas; Bein, Berthold; Hanß, R.; Paris, Andrea; Fudickar, Wolfgang; Scholz, Jens; Tonner, Peter H.

doi:10.1213/01.ane.0000184041.32175.14

Cited by 142 publications

(91 citation statements)

References 17 publications

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“…Inhibitory effects of propofol on the sympathoadrenal system have been documented [7]. The results of some other similar studies are comparable with those obtained in this investigation [7][8][9][10]. In contrast, there are findings which document significantly increased endocrine stress response in a TIVA-propofol group of patients [11,12], or no difference between compared anesthetic regimens [13].…”

Section: Discussionsupporting

confidence: 81%

Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl

et al. 2008

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AbstractThe study was designed to determine pre-, intra-and postoperative serum cortisol and prolactin (PRL) concentrations in patients subjected to low abdominal surgery under total intravenous anesthesia (TIVA) with propofol-fentanyl, and under general balanced anesthesia with isoflurane-fentanyl. The prospective study included 50 patients of both sexes, aged between 35 and 60 years, subjected to elective low abdominal surgery. Patients were randomly divided into two groups: an experimental group, consisting of 25 ASA I/II (American Society of Anesthesiologists I/II classification) patients treated under TIVA with propofol-fentanyl, and a control group consisting of 25 ASA I/II patients treated under balanced anesthesia with isoflurane-fentanyl. The length of the surgery and the degree of the surgical trauma did not differ significantly between the two anesthesia groups. Blood samples for cortisol and PRL measurements were drawn at exact time points: 30 minutes before the beginning of the surgery (T0), 30 minutes after the beginning of the surgery (T1), at the end of the surgery (T2), 2 hours after the surgery (T3), and 24 hours after the surgery (T4). Serum levels of cortisol and PRL were measured using commercially available kits. The results were evaluated with the nonparametric Mann-Whitney test. The serum concentration of cortisol measured at T1 time point in patients treated under TIVA was significantly lower (p=0.04) than that in patients treated under general balanced anesthesia. The average circulating levels of PRL measured at T1, T2 and T3 time points in patients treated under TIVA were significantly lower (p=0.003; p=0.002; p<0.05; respectively) than those in patients treated under balanced anesthesia. The results obtained suggest that the endocrine stress response developed in response to surgery is probably attenuated in patients treated under TIVA with propofol-fentanyl and, thus, that these patients are less stressed in comparison to patients treated under general balanced anesthesia with isoflurane-fentanyl.

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Section: Discussionsupporting

confidence: 81%

Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl

et al. 2008

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“…General anesthetic agents also alter ECG intervals, and they decrease heart rate variability in humans (Ledowski et al, 2005). Here, we report that HRV is increased by pentobarbital in mice.…”

Section: Discussionmentioning

confidence: 61%

Identification of a Molecular Target Mediating the General Anesthetic Actions of Pentobarbital

et al. 2006

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Barbiturates were introduced into medical practice in 1934. They are widely used today as general anesthetics. Although in vitro studies revealed that the activity of a variety of ligandgated channels is modulated by barbiturates, the target(s) mediating the anesthetic actions of barbiturates in vivo are unknown. Studying pentobarbital action in ␤3(N265M) mice harboring ␤3-containing GABA A receptors insensitive to a variety of general anesthetic agents, we found that the immobilizing action of pentobarbital is mediated fully, and the hypnotic action is mediated in part by this receptor subtype. It was surprising that the respiratory depressant action of pentobarbital is indistinguishable between ␤3(N265M) and wild-type mice and thus is mediated by other as-yet-unidentified targets. Whereas the target for the immobilizing and hypnotic actions of pentobarbital seems to be the same as for etomidate and propofol, these latter agents' respiratory depressant actions are mediated by ␤3-containing GABA A receptors. Thus, in contrast to etomidate and propofol, pentobarbital can elicit respiratory depression by a ␤3-independent pathway. Pentobarbital reduced heart rate and body temperature to a slightly smaller extent in ␤3(N265M) mice compared with wild-type mice, indicating that these actions are largely mediated by other targets. Pentobarbital-induced increase of heart rate variability and prolongation of ECG intervals are seen in both ␤3(N265M) mice and wild-type mice, suggesting that they are not dependent on ␤3-containing GABA A receptors. In summary, we show a clear pharmacological dissociation of the immobilizing/hypnotic and respiratory/cardiovascular actions of pentobarbital.The introduction of general anesthetics into medical practice 160 years ago has revolutionized surgery. However, the mechanisms of action of this class of drugs are still only poorly understood. Although general anesthetics have been shown to modulate the activity of a number of proteins (e.g., ligand-gated ion channels; Krasowski and Harrison, 1999) and two-pore domain potassium channels in vitro (Franks and Honore, 2004), the identification of targets mediating specific actions of general anesthetics in vivo has only just begun.GABA A receptors are pentameric ligand-gated ion channels, the majority of them containing two ␣, two ␤, and one ␥ subunit (Backus et al., 1993;Chang et al., 1996). Mutagenesis studies have identified amino acid residues in GABA A receptor ␤ subunits that are crucial for the actions of the general anesthetics etomidate and propofol in vitro (Belelli et al., 1997;Mihic et al., 1997;Krasowski et al., 1998;Siegwart et al., 2002Siegwart et al., , 2003.It has been shown that ␤3(N265M) mice are insensitive to the immobilizing and respiratory depressant action of etomidate and propofol and have a reduced sensitivity to the hypnotic action of these drugs, suggesting that ␤3-containing GABA A receptors mediate these actions, whereas etomidate retains its sedative (motor depressant) action at subanesthetic doses (Jur...

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“…24 The effects of sevoflurane on these stress hormones are controversial, 25,26 but it is thought that propofol combined with opioids may prevent the increase in catecholamines induced by surgery. 27,28 Adrenaline and Data are means ± SD. **P < 0.01 and ***P < 0.001 versus baseline; † P < 0.05, † † P < 0.01 and † † † P < 0.001 for the TIVA group versus the VIMA group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Stress Hormone Response, Interleukin-6 and Anaesthetic Characteristics of Two Anaesthetic Techniques: Volatile Induction and Maintenance of Anaesthesia using Sevoflurane versus Total Intravenous Anaesthesia using Propofol and Remifentanil

et al. 2009

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This prospective randomized study compared the effects of two types of anaesthesia on peri-operative anaesthetic profiles from induction to recovery and on immunological and neurohormonal responses to anaesthesia and surgical stress. Forty patients were assigned to undergo either volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane or total intravenous anaesthesia (TIVA) with propofol and remifentanil. Plasma adrenaline, noradrenaline, cortisol, glucose and interleukin-6 (IL-6) levels were measured at baseline, induction, incision and extubation. TIVA produced a significantly lower intubation score, shorter time to intubation and faster waking time than VIMA, but recovery profiles did not differ. Adrenaline, noradrenaline, cortisol and glucose levels were significantly lower with TIVA than VIMA, but there was no difference in IL-6 levels between the two groups.TIVA with propofol and remifentanil may be preferable to VIMA with sevoflurane alone because it leads to smoother, more rapid induction, more rapid awakening and lower stress responses to surgical stimuli.

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Neuroendocrine Stress Response and Heart Rate Variability: A Comparison of Total Intravenous Versus Balanced Anesthesia

Cited by 142 publications

References 17 publications

Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl

Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl

Identification of a Molecular Target Mediating the General Anesthetic Actions of Pentobarbital

Comparison of Stress Hormone Response, Interleukin-6 and Anaesthetic Characteristics of Two Anaesthetic Techniques: Volatile Induction and Maintenance of Anaesthesia using Sevoflurane versus Total Intravenous Anaesthesia using Propofol and Remifentanil

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