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2015, Number 2

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Rev Cubana Cardiol Cir Cardiovasc 2015; 21 (2)

Surgical treatment of stress in Abdominal Aorta Surgery, by two different anesthetic techniques

Correa PJM, López CO, Pichardo GC, Medina GY

Language: Spanish
References: 23
Page: 85-93
PDF size: 478.81 Kb.


ABSTRACT

Introduction: The surgery of abdominal aortic is one of the types of surgerythat bigger surgical stress takes implicit. A great quantity of stimuli like endocrine answer is unchained to the surgery, the techniques anesthetic employees could influence in the attenuation of the answer of stress of the organism before the surgical aggression.
Objectives: To evaluate the neuroendocrine answer to the stress, taken place in intervened patients of surgery of the abdominal aorta under it general orotraqueal anesthesia or general orotraqueal-peridural combined anesthesia.
Materials and method: It was carried out a prospective, longitudinal, controlled, randomized clinical investigation, of intervention in parallel groups; in the period of January of 2009 to December of 2012, in 30 patients, of any sex, with age among 50 and 80 years, that went to the CIMEQ, with atherosclerotic illnesses of the abdominal aorta and they required surgical treatment.
Results: 83.3% of the cases were masculine; the half age was of 68.9 (ED 6.8) years. The cortisol levels, ACTH and prolactina had similar behavior in the two groups. All the hormones showed an important elevation after the surgical incision, of the extubation and at the 24 hours of the postoperative one, however, in these three moments, the values measured in the group intervened under general orotraqueal anesthesia, they were much bigger when they were compared with those of the group where general orotraqueal-peridural combined was used.
Conclusions: The general orotraqueal-peridural combined anesthesia is a surer and more effective anesthetic method in the handling of the anesthetic-surgical stress, when it is compared with the general orotraqueal anesthesia.


REFERENCES

  1. Dhabhar Firdaus S. Enhancing versus suppressive effects of stress on immune function: implications for immunoprotec-tion and immunopathology. Neuroimmunomodulation 2009; 16:300–317.

  2. Girn HR, Ahilathirunayagam S, Mavor AI, Homer-Vanniasinkam S. Reperfusion syndrome: cellular mechan-isms of microvascular dysfunction and potential therapeutic strategies. Vasc Endovascular Surg 2007; 41(4):277–93.

  3. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000; 85:109–17.

  4. The writing group for the PEPI trial. Effect of estrogen or es-trogen/progestin regimes on heart disease risk factors in postmenopausal women. JAMA 1995; 273:199-208.

  5. Goldman A, Hoehne C, Fritz GA, Unger J, Ahlers O et al. Combined vs. Isoflurane/Fentanyl anesthesia for major ab-dominal surgery: Effects on hormones and hemodynamics. Med Sci Monit. 2008; 14(9):CR445-52.

  6. Schricker T. Galeone M, Wykes L, Carli F. Effect of desflu-rane/remifentanilanaesthesia on glucosemetabolism during surgery: a comparison withdes flurane/epidural anaesthesia. ActaAnaesthesiolScand 2004; 48:169-173.

  7. Buyukkocak U, Daphan C, Caglayan O, Aydinuraz K, Kaya T, Saygun O, et al. Effects of Different Anesthetic Tech-niques on Serum Leptin, C-reactiveProtein, and Cortisol Concentrations in Anorectal Surgery. Croat Med J 2006; 47:862-8.

  8. Buyukkocak U, Caglayan O, Daphan C, Aydinuraz K, Say-gun O et al. Similar Effects of General and Spinal Anaesthe-sia on Perioperative Stress Response in Patients Undergoing Haemorrhoidectomy. Mediators of Inflammation2006; Ar-ticle ID 97257:1–5.

  9. Ilies C, Gruenewald M, Ludwigs J, Thee C, Höcker J, et al. Evaluation of the surgical stress index during spinaland gen-eral anaesthesia. British Journal of Anaesthesia 2010; 105(4):533–7.

  10. Tacconi F, Pompeo E, Sellitri F, Mineo TC. Surgical stress hormones response is reduced after a wake videothoracosco-py. Interactive Cardiovascular and ThoracicSurgery2010; 10:666–671.

  11. Caputo M, Alwair H, Rogers CA, Ginty M, Monk C, et al. Myocardial, inflammatory and stress responses in Off-Pump Coronary Artery Bypass Graft surgery with thoracic epidural anesthesia. Ann ThoracSurg 2009; 87:1119 –26.

  12. Humphreys N, Bays SM, Parry AJ, Pawade A, Heyderman RS. Spinal anesthesia with an indwelling catheter reduces the stress response in pediatric open heart surgery. Anesthesiolo-gy 2005; 103:1113–20.

  13. Winterhalter M, Brandl K, Rahe-Meyer N, Osthaus A, Heck-er H, et al. Endocrine stress response and inflammatory acti-vation duringCABG surgery. A randomized trial comparing remifentanilinfusion to intermittent fentanyl. European Jour-nal of Anaesthesiology 2008; 25:326–335.

  14. Rodríguez R, Martínez E, Santana M, Rodríguez F. Estudio de la respuesta al estrés en dos técnicas analgésicas (remifen-tanilo continuo frente a fentanilo en bolos) valorandodiferen-tes marcadores (citocinas, proteína C reactiva y cortisol)en el intra y postoperatorio de histerectomías abdominales. Rev Esp Anestesiol Reanim 2007; 54:221-226.

  15. Ahlers O, Nachtigall I, Lenze J, Goldmann A, Schulte E et al. Intraoperative thoracic epidural anaesthesia attenuates stress-induced immunosuppression in patients undergoing major abdominal surgery. British Journal of Anaesthesia 2008; 101(6):781–7.

  16. Yuhong L, Shengmei Z, Meijuan Y. Combined gener-al/epidural anesthesia (Ropivacaine0.375%) versus general anesthesia for upper abdominal surgery. Anesth Analg 2008; 106:1562–5.

  17. Nizamoglu A, Salihoglu Z, Bolayirh M. Effects of epidural-and-general anesthesia combined versus general anesthesia during laparoscopic adrenalectomy. Surg Laparosc Endosc-Percutan Tech 2011; 21:372–379.

  18. Papadima A, Boutsikou M, Lagoudianakis EE, Kataki A, Konstadoulakis M, Georgiou L, Katergiannakis V, Manouras A.Lymphocyte apoptosis after major abdominal surgery is not influenced by anesthetic technique: a comparative study of general anesthesia versus combined general and epidural analgesia.J ClinAnesth 2009; 21(6):414-21.

  19. Zura M, Kozmar A, Sakic K, Malenica B, Hrgovic Z. Effect of spinal and general anesthesia on serum concentration of pro-inflammatory and anti-inflammatory cytokines. Immu-nobiology 2012; 217(6):622-7.

  20. Li Y, Zhu S, Yan M. Combined general/epidural anesthesia (ropivacaine 0.375%) versus general anesthesia forupperab-dominal surgery. AnesthAnalg2008; 106(5):1562-5.

  21. Qu DM, Jin YF, Ye TH, Cui YS, Li SQ, Zhang ZY.The ef-fects of general anesthesia combined with epidural anesthesia on the stress response in thoracic surgery. Zhonghua Yi Xu-eZaZhi 2003; 83(5):408-11.

  22. Kasachenko VM, Briskin BS, Evstifeeva OV, Savchenko ZI. The impact of the type of anesthesia on stress-realizing and stress-limiting mechanisms of the immune system in geronto-logical patients at abdominal surgeries. Eksp Klin Gastroen-tero 2004; 105(3):58-61.

  23. Bravo Cuéllar A, Romero Ramos JE, Hernández Flores G, Romo Pérez FJ, Bravo Cuéllar L et al. Comparación de dos técnicas anestésicas sobre losniveles plasmáticos de marca-dores inflamatorios. Cir Ciruj 2007; 75:99-105.




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