Galician Medical Journal (Jun 2016)
Dynamics of Changes in Marker of Surgical Stress Cortisol in Transduodenal Endoscopic Surgery Depending on Method of General Anaesthesia
Abstract
There are different types of anaesthetic management of patients undergoing transduodenal endoscopic surgery. However, there is no clear and universally accepted algorithm to choose the method of anaesthesia. The objective of the research was to compare dynamics of surgical stress by cortisol levels in the blood of patients who underwent transduodenal endoscopic surgery using various types of anaesthetic tactics. Material and methods. Prospective evaluation of anaesthetic technique for transduodenal endoscopic surgery in three groups of patients with obstructive jaundice was made. Group I included 25 patients who received superficial sedation with the preservation of spontaneous breathing (propofol + phentanyl). Tracheal intubation and artificial lung ventilation (propofol + phentanyl + Tracrium) under general anaesthesia were performed in 25 patients of Group II in order to carry out endoscopic retrograde cholangiopancreatography. Group III included 50 patients who received deep sedation with propofol and phentanyl and were ventilated with the synchronized intermittent mandatory ventilation (SIMV) mode using the gastro-laryngeal tube when undergoing endoscopic retrograde cholangiopancreatography. To assess stress response to surgery when using three different anaesthetic strategies dynamics of changes in cortisol levels in the blood was studied. Results. In patients of all groups a significant increase in the initial levels of cortisol was detected due to psychological and emotional arousal prior to surgery. During the main stage of endoscopic surgery the level of cortisol decreased compared to the initial values in patients of all groups. In patients of Group III and Group II cortisol levels were the lowest due to the elimination of psychological and emotional stress and protective effects of general anaesthesia. A high level of cortisol in patients of Group I was explained as a consequence of the negative impact of several unfavorable factors being typical for this type of anaesthesia: subclinical hypoxemia, hypercapnia, arterial hypertension, etc. Conclusions. Intravenous anaesthesia with the use of the SIMV mode and the gastro-laryngeal tube provides the minimum level of surgical stress. Among all types of anaesthetic tactics being used by us this type is the safest for a patient and the most convenient to an endoscopist.
