Combination of Epidural Anesthesia and General Anesthesia Attenuates Stress Response to Renal Transplantation Surgery

被引:58
作者
Hadimioglu, N. [1 ]
Ulugol, H. [1 ]
Akbas, H. [2 ]
Coskunfirat, N. [1 ]
Ertug, Z. [1 ]
Dinckan, A. [3 ]
机构
[1] Akdeniz Univ, Dept Anesthesiol & Reanimat, TR-07050 Antalya, Merkez, Turkey
[2] Akdeniz Univ Hosp, Dept Clin Biochem, Antalya, Turkey
[3] Akdeniz Univ Hosp, Dept Gen Surg, Antalya, Turkey
关键词
INSULIN-RESISTANCE; SERUM INTERLEUKIN-6; METABOLIC-RESPONSE; ELECTIVE SURGERY; DISEASE; ANALGESIA; REJECTION; NECROSIS; CHILDREN; GLUCOSE;
D O I
10.1016/j.transproceed.2012.08.004
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Choice of the anesthestic technique can reduce or even eliminate stress responses to surgery and decrease the incidence of complications. Our aim was to compare a combination of epidural anesthesia+general anesthesia with general anesthesia alone as regards perioperative insulin resistance and inflammatory activation among renal transplant recipients. Forty-six nondiabetic patients undergoing renal transplantation were prospectively randomized to the epidural anesthesia + general anesthesia group (n = 21), or general anesthesia alone group (n = 25). Plasma levels of glucose, insulin, interleukin (IL)-6, tumour necrosis factor (TNF)-alpha, resistin, and adiponectin were measured at baseline (T1), end of surgery (T2), postoperative first hour (T3), postoperative second hour (T4) and postoperative 24th hour (T5). Homeostasis model assessment-estimated insulin resistance (HOMA-IR) scores were calculated at every time point that the blood samples were collected. Glucose levels (P < .001) and insulin levels at the end of surgery (P = .048) and at postoperative first hour (P = .005) and HOMA-IR levels at the end of surgery (P = .012) and at postoperative first hour (P = .010) showed significantly higher values among the general anesthesia alone group when compared with the epidural+general anesthesia group. TNF-alpha levels at postoperative 2nd and at 24th hour (P = .005 and P = .004, respectively) and IL-6 levels at postoperative 1st and 2nd hours (P = .002 and P = .045, respectively) were significantly higher in the general anesthesia alone group when compared with the epidural+general anesthesia group. The TNF-alpha levels were significantly less at all time points when compared with baseline only in the epidural+general anesthesia group (T1, 33.36 vs 37.25; T2, 18.45 vs 76.52; T3, 15.18 vs 78.27; T4, 10.75 vs 66.64; T5, 2.98 vs 36.32) Hospital stays were significantly shorter among the epidural+general anesthesia group (P = .022). We showed partly attenuated surgical stress responses among patients undergoing renal transplantation using general anesthesia combined with epidural anesthesia compared with general anesthesia alone.
引用
收藏
页码:2949 / 2954
页数:6
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