Effects of total intravenous anesthesia and combined intravenous and inhalation anesthesia on blood glucose and cortisol in spinal neurosurgery

中国医师进修杂志 Pub Date : 2010-09-25 DOI:10.3760/CMA.J.ISSN.1673-4904.2010.27.006

Hai-yang Liu, Tong-yan Chen, Zeng Heng-yu, R. Han

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Abstract

Objective To investigate the effects of total intravenous anesthesia (TIVA) and combined intravenous and inhalation anesthesia on blood glucose and cortisol in spinal neurosurgery.Methods Forty-four spinal neurosurgery patients were divided into propofol combined with remifentanil group (PR group) and sevoflurane combined with remifentanil group (SR group ), 22 cases in each group,they were induced with propofol, sufentanil and rocuronium. Anesthesia was maintained with sevoflurane in SR group while propofol in PR group. Depth of anesthesia adaption according to bispectral index (BIS)(45 -55). Blood glucose, cortisol, haemodynamics were observed at different time points. Results The mean arterial pressure(MAP) was higher after induction in PR group than that in SR group(P ＜ 0.05 ). Sixty minutes after induction, MAP was lower than that before induction in PR group (P ＜ 0.05 ). Heart rate ( HR )in both SR group and PR group were lower at 60 and 120 minutes after induction than those before induction (P ＜ 0.05). HR was lower at 5 minutes after induction in PR group than that in SR group (P ＜ 0.05). No significant difference was showed in blood glucose and cortisol between the two groups (P ＞ 0.05 ). Cortisol level was significantly lower at 120 minutes after induction than that before induction [(40.6 ± 18.3) μg/L vs. ( 129.7 ± 36.7 ) μg/L, P ＜ 0.05 ] and at 24 hours postoperative [ (93.6 ± 19.8 ) μg/L ] recovered to the level before induction in PR group. Cortisol level was significantly higher before induction than 120 minutes after induction [ ( 130.5 ± 32.1 ) μg/L vs. (51.6 ± 16.8 ) μg/L, P ＜ 0.05 ] and 24 hours postoperative was (75.9 ± 18.2) μg/L in SR group. Conclusions Two anesthetic regimens are compatible during spinal neurosurgery, with no apparent fluctuations of perioperative blood glucose. However, longer cortisol inhibition is probably happened when using sevoflurane. Key words: Anesthesia, intravenous; Anesthesia, inhalation; Blood glucose; Hydrocortisone; Spinal neurosurgery

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静脉全麻与静脉吸入复合麻醉对脊柱神经外科患者血糖、皮质醇的影响

目的探讨全静脉麻醉(TIVA)与静脉吸入联合麻醉对脊柱神经外科手术患者血糖、皮质醇的影响。方法将44例脊柱神经外科患者分为异丙酚联合瑞芬太尼组(PR组)和七氟醚联合瑞芬太尼组(SR组)，每组22例，分别用异丙酚、舒芬太尼和罗库溴铵诱导。SR组以七氟醚维持麻醉，PR组以异丙酚维持麻醉。根据双谱指数(BIS)(45 -55)调整麻醉深度。观察不同时间点血糖、皮质醇、血流动力学变化。结果PR组诱导后平均动脉压(MAP)高于SR组(P < 0.05)。诱导60 min后，PR组MAP低于诱导前(P < 0.05)。SR组和PR组的心率(HR)在诱导后60、120 min均低于诱导前(P < 0.05)。PR组诱导后5 min HR低于SR组(P < 0.05)。两组血糖、皮质醇比较差异无统计学意义(P < 0.05)。PR组诱导后120 min皮质醇水平明显低于诱导前[(40.6±18.3)μg/L vs(129.7±36.7)μg/L, P < 0.05]，术后24 h[(93.6±19.8)μg/L]恢复到诱导前水平。诱导前皮质醇水平显著高于诱导后120 min[(130.5±32.1)μg/L vs(51.6±16.8)μg/L, P < 0.05]，术后24 h SR组皮质醇水平为(75.9±18.2)μg/L。结论两种麻醉方案在脊柱神经外科手术中是相容的，围手术期血糖无明显波动。然而，当使用七氟醚时，可能会发生更长时间的皮质醇抑制。关键词:麻醉;静脉注射;吸入麻醉;血糖;氢化可的松;脊髓神经外科

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中国医师进修杂志

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期刊介绍： Chinese Journal of Postgraduates of Medicine (founded in 1978, monthly) is one of the series of journals of the Chinese Medical Association (CMA) under the supervision of the National Health Commission of the People's Republic of China, sponsored by the Chinese Medical Association (CMA) and Dalian Institute of Theoretical Medicine (DITM). It is a core journal of Chinese science and technology, a statistical source journal of Chinese scientific and technical papers, and a statistical source journal of China Academic Journal Impact Factor Annual Report. The journal adheres to the purpose of using continuing medical education and post training, highlights new theories, new knowledge, new methods and new technologies, and focuses on the combination of theory and practice, and the combination of popularisation and improvement. Main columns: Special tutorials, expert forums, clinical treatises, clinical experience, reviews and lectures, continuing medical education, teaching and research, advanced training forum, drugs and clinics, overview of progress, introduction of new technologies, imaging and clinics, lessons learnt, discussions and evaluations, case reports, discussions of clinical cases, conference proceedings, and domestic and international academic developments. The main target readers are clinical medical personnel in internal medicine, surgery, gynaecology, paediatrics and ophthalmology.