Comparison of the effects of isoflurane and sevoflurane on surgical stress in intracranial tumor surgery

Abstract

Objectives: Surgeries can trigger stress responses including metabolic and hormonal changes. It is important to suppress stress response during surgery. We compared the effects of isoflurane and sevoflurane on surgical stress in intracranial tumor surgery.

Methods: Thirty ASA physical status I, II, III patients, scheduled for elective craniotomies, were enrolled in this prospective, randomized study. Anesthesia was induced with sodium thiopental fentanyl and vecuronium bromide and maintained with a 50% oxygen-air mixture along with isoflurane or sevoflurane. Venous blood was sampled to measure cortisol, ACTH and prolactin levels 24 hours before surgery, 1 min before anesthesia induction, during tumor removal, 1 min after extubation, at 3, 6, 12, 24, 48 hours.

Results: There was no statistically significant difference between two groups regarding demographic characteristics of patients. In group I, ACTH levels were significantly higher 1 min after extubation, at 3 and 6 hours. In Group S, significant increases were observed during tumor removal, 1 min after extubation, at 3 and 6 hours. Cortisol levels were significantly higher in both group after tumor removal, 1 min after extubation, at 3, 6, 12 and 24 hours. Prolactin levels were significantly higher in Group I during tumor removal, after extubation, at 3 and 6 hours. In group S, significant increase in prolactin level was observed only during tumor removal and 1 min after extubation. There were no significant differences in ACTH, cortisol and prolactin values between the two groups.

Conclusions: Using isoflurane or sevoflurane for anesthesia during intracranial tumor surgery are not superior to each other regarding hemodynamic and hormonal stress response.

Keywords

• surgical stress
• isoflurane
• sevoflurane
• catecholamines
• ACTH
• cortisol

References

1. 1. Breslow MJ. Clinical Implications of the stress response to surgery. In: Rogers, MC., Tinker, JH., Covino, BG., Longnecker D, ed. Principles and Practice of Anesthesiology. 2nd. Mosby; 1998:103-120.
2. 2. Chi OZ, Choi YK, Lee DI, Kim YS, Lee I. Intraoperative mild hypothermia does not increase the plasma concentration of stress hormones during neurosurgery. Can J Anaesth 2001;48:815-8.
3. 3. Galley HF, DiMatteo MA, Webster NR. Immunomodulation by anaesthetic, sedative and analgesic agents: does it matter? Intensive Care Med 2000;26:267-74.
4. 4. Torri G. Inhalation anesthetics: a review. Minerva Anestesiol 2010;76:215-28.
5. 5. Milde LN. Cerebral protection. In: Cucchiara RF, Black S, Mchenfelder JD (eds.). Clinical Neuroanesthesia. New York: Churchill Livingstone, 1998: pp.177-228.
6. 6. Yörükoğlu D. Tümör cerrahisinde anestezi. In: Kecik Y, ed. Nöroanestezi. 1. Baskı. Ankara: Atlas Yayıncılık; 2000:171-198.
7. 7. Kehlet H. The surgical stress response: should it be prevented? Can J Surg 1991;34:565-7.
8. 8. Chrousos GP. The role of stress and the hypothalamic–pituitary–adrenal axis in the pathogenesis of the metabolic syndrome: neuro-endocrine and target tissue-related causes. Int J Obes 2000;24:S50-5.

9. 9. Aono H, Takeda A, Tarver SD, Goto H. Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy. J Clin Anesth 1998;10:546-50.
10. 10. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000;85:109-17.
11. 11. Besnier E, Clavier T, Compere V. The hypothalamic-pituitary-adrenal axis and anesthetics: a review. Anesth Analg. 2017;124:1181-9.
12. 12. Marana E, Annetta MG, Meo F, Parpaglioni R, Galeone M, Maussier ML, et al. Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery. Can J Anesth 2003;50:348-54.
13. 13. Naito Y, Tamai S, Shingu K, Shindo K, Matsui T, Segawa H, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology 1992;77:426-31.
14. 14. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology 1995;82:1474-506.
15. 15. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology 1990;73:308-27.
16. 16. Geze S, Yilmaz AA, Tuzuner F. The effect of scalp block and local infiltration on the haemodynamic and stress response to skull-pin placement for craniotomy. Eur J Anaesthesiol 2009;26:298-303.
17. 17. Kendrišić M, Šurbatović M, Djordjević D, Trifunović B, Jevdjić J. Analgesic efficacy and safety of four different anesthesia/postoperative analgesia protocols in patients following total hip arthroplasty. Vojnosanit Pregl 2017;74:814-20.
18. 18. Scherpereel P. Endocrine, Immune and Metabolic stress responses to surgery. In: XXXVIII.Türk Anesteziyoloji ve Reanimasyon Kongresi-2004 Özet Kitabı. 2004:234-235.
19. 19. Wang XW, Cao JB, Lv BS, Mi W, Wang Z, Zhang C, et al. Effect of perioperative dexmedetomidine on the endocrine modulators of stress response: a meta-analysis. Clin Exp Pharmacol Physiol 2015;42:828-36.
20. 20. Kain ZN, Zimolo Z, Heninger G. Leptin and the perioperative neuroendocrinological stress response. J Clin Endocrinol Metab 1999;84:2438-42.
21. 21. Goto Y, Ho SL, McAdoo J, Fanning NF, Wang J, Redmond HP, et al. General versus regional anaesthesia for cataract surgery: effects on neutrophil apoptosis and the postoperative pro-inflammatory state. Eur J Anaesthesiol 2000;17:474-80.
22. 22. Segawa H, Mori K, Murakawa M, Kasai K, Shirakami G, Adachi T, et al. Isoflurane and sevoflurane augment norepinephrine responses to surgical noxious stimulation in humans. Anesthesiology 1998;89:1407-13.
23. 23. Ura T, Higuchi H, Taoda M, Sato T. Minimum alveolar concentration of sevoflurane that blocks the adrenergic response to surgical incision in women: MAC(BAR). Eur J Anaesthesiol 1999;16:176-81.
24. 24. Miura Y, Mackensen GB, Nellgård B, Pearlstein RD, Bart RD, Dexter F, et al. Effects of isoflurane, ketamine, and fentanyl/N2O on concentrations of brain and plasma catecholamines during near-complete cerebral ischemia in the rat. Anesth Analg 1999;88:787-92.
25. 25. Hase K, Meguro K. Perioperative stress response in elderly patients for elective gastrectomy -The comparison between isoflurane anesthesia and sevoflurane anesthesia both combined with epidural anesthesia. Japanese J Anesthesiol 2000;49:128-9.
26. 26. Murakawa T, Tsubo T, Ogasawara H, Takahashi S, Kudo T, Matsuki A. Plasma cortisol levels during abdominal surgery under sevoflurane anesthesia: comparison between gastrointestinal and gynecological surgery. Japanese J Anesthesiol 1990;39:723-7.
27. 27. Roth-Isigkeit AK, Schmucker P. Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery. Steroids 1997;62:695-9.
28. 28. Marana E, Colicci S, Meo F, Marana R, Proietti R. Neuroendocrine stress response in gynecological laparoscopy: TIVA with propofol versus sevoflurane anesthesia. J Clin Anesth 2010;22;250-5.
29. 29. Marana E, Russo A, Colicci S, Polidori L, Bevilacqua F, Viviani D, et al. Desflurane versus sevoflurane: a comparison on stress response. Minerva Anestesiol 2013;79:7-14.
30. 30. Krog AH, Thorsby PM, Sahba M, Pettersen EM, Sandven I, Jørgensen J, et al. Perioperative humoral stress response to laparoscopic versus open aortobifemoral bypass surgery. Scand J Clin Lab Invest 2017;77:83-92.
31. 31. Nishiyama T, Yamashita K, Yokoyama T. Stress hormone changes in general anesthesia of long duration: Isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia. J Clin Anesth 2005;17:586-91.
32. 32. Mustola S, Parkkari T, Uutela K, Huiku M, Kymäläinen M, Toivonen J. Performance of surgical stress index during sevoflurane-fentanyl and isoflurane-fentanyl anesthesia. Anesthesiol Res Pract 2010;2010:810721.