Stress and fluid restriction before anesthesia induction, investigation of the effects of the patient’s clinic, endocrine responses, and the level of the Nesfatin-1

Abstract

Background/Aim: Preoperative fasting, fluid restriction and stress trigger many hormonal responses, one of which is the newly described Nefsatin-1. It has important effects on energy metabolism and stress. In this study, we aimed to examine the relationship between stress, fasting, fluid restriction, and Nesfatin-1. Methods: A total of 100 ASA I-II adult patients between 18 and 60 years of age with no psychiatric, cardiovascular, or metabolic disorders, who were operated under general anesthesia for various reasons at Fırat University Hospital between June and November 2013 were included in this randomized prospective case-control study. Patients were categorized into fluid restriction (Group 1) and no-fluid restriction (Group 2) groups. These groups were further sub-categorized as those receiving (Groups 1A and 2A) and not receiving pre-medication (Group 1B and Group 2B). State Trait Anxiety Inventory was applied to all patients by an independent member of the research team before the surgical procedure. Also, blood samples were obtained 6-8 hours, 1 hour, and just before the induction to measure insulin, glucose, epinephrine, norepinephrine, cortisol, and Nesfatin-1 levels. Results: In both groups, the test score for pre-operative anxiety was 44. While there were no differences in serum insulin levels between the study groups (P>0.05), serum glucose and epinephrine levels were higher in Group 1A than in other groups (P<0.05 for both). Except for the 2nd period, serum norepinephrine levels were elevated in all stages (P<0.05). Serum cortisol levels were higher in Group 2B (P<0.05), while serum Nesfatin-1 levels were higher in Group 2A (P<0.05). Conclusion: According to our findings, the highest reflection of stress in patients, together with clinical and endocrine responses, coincided just before the induction period. Further studies are warranted before firmer conclusions can be drawn regarding the association between Nesfatin-1 and anxiety. We believe that if the pathophysiological mechanisms between anxiety and Nesfatin-1 are clarified, Nesfatin-1 targeting treatment approaches can be tried in the clinic.

Keywords

• Surgery
• Premedication
• Fluid restriction
• Anxiety
• Nesfatin-1

Kaynakça

1. 1. Diks J, van Hoorn DEC, Nijveldt RJ, Boelens PG, Hofman Z, Bouritius H, et al. Preoperative fasting: an outdated concept? J Parenter Enteral Nutr. 2005;29:298-30.
2. 2. Derbyshire DR, Smith G. Sympathoadrenal responses to anesthesia and surgery. Br J Anaesth. 1984;56:725-39.
3. 3. Misiolek H, Wojcieszek E, Dyaczynska-Herman A. comparison of influence of thiopentone, propofol and midazolam on blood serum concentration of noradrenaline and cortisol in patients undergoing non-toxic struma operation. Med Sci Monit. 2000;6:319-24.
4. 4. Su Y, Zhang J, Tang Y, Bi F, Liu JN. The novel function of Nesfatin-1: anti-hyperglycemia. Biochem Biophys Res Commun. 2010;391:1039-42.
5. 5. Gonzalez R, Mohan H, Unniappan S. Nucleobindins: Bioactive precursor proteins encoding putative endocrine factors? Gen Comp Endocrinol. 2012;176:341-6.
6. 6. Ito C. The role of brain histamine in acute and chronic stresses. Biomedicine & Pharmacotherapy. 2000;54:263-7.
7. 7. Foo KS, Brauner H, Ostenson CG, Broberger C. Nucleobindin-2/Nesfatin in the endocrine pancreas: Distribution and relationship to glycemic state. J Endocrinol. 2010;204:255–63.
8. 8. Goebel M, Stengel A, Wang L, Taché Y. Restraint stress activates Nesfatin-1-immunoreactive brain nuclei in rats. Brain Res. 2009;1300:14-24.

9. 9. Whitty PM, Goodwin DR. Patient satisfaction with general anesthesia. Anesthesia. 1996;51:32.
10. 10. Hume MA, Kennedy B, Asbury AJ. Patient knowledge anesthesia and perioperative care. Anesthesia. 1994;49:715-8.
11. 11. Ramsay MA. A survey of pre-operative fear. Anesthesia. 1972;27:396–402.
12. 12. Chew ST, Tan T, Tan SS, Ip-Yam PC. A survey of patient knowledge of anesthesia and perioperative care. Singapore Med J. 1998;39:399–402.
13. 13. Egbert LD, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patients. N Engl J Med. 1964;270:7.
14. 14. Kayhan Z (ed). Metabolic / endocrine system and anesthesia. clinical anesthesia. Logos publishing, Ankara. 2004;16:406-16.
15. 15. Ledowski T, Bein B, Hanss R, Paris A, Fudickar W, Scholz J, et al. Neuroendocrine stress response and heart rate variability: a comparison of total intravenous versus balanced anesthesia. Anesth Analg. 2005;101:1700-5.
16. 16. Taşdemir A, Erakgün A, Deniz MN, Çertuğ A. Comparison of preoperative and postoperative: Anxiety levels with state-trait anxiety inventory test in preoperatively informed patients. Turk J Anaesth Reanim. 2013;41:44-9.
17. 17. Domar AD, Everett LL, Keller MG. Preoperative anxiety: Is it a predictablentity? Anesth Analg. l989;69:763-7.
18. 18. Wallash B. Trauma Shoemoker WC. Textbook of critical care. 4nd edition. Londo WB Saunders Company 1998:1230-321.
19. 19. Şahinoğlu AH. Intensive care problems and treatments. 2nd Edition. Trauma. Ortadoğu Advertisement Presentation and Publishing. Ankara 2003;311-30.
20. 20. Malazgirt Z. Şahinoğlu AH. Neuroendocrine, immune and metabolic responses to trauma. Intensive Care problems and treatments. Ankara: Türkiye Klinikleri. 2003;2:305-30.
21. 21. Lowrie A, Johnson PL, Fell D, Robinson W. Cardiovascular and plasma catecholamine responses at tracheal extubation. Br J Anaesth. 1992;68:261-3.
22. 22. Donald SP, Whitley JM, Caral LT, Dwight DD, Dougles SD. Small volume resuscitation from hemorrhagic shock in dogs: Effects on systemic hemodynamic and systemic blood flow. Critical Care Med. 1991;19:364-71.
23. 23. Guyton AC, Hall JE. Autonomic nervous system and adrenal gland medulla. Medical Physiology (Translation) 10th Edition, İstanbul:Nobel Tıp Kitapevleri, 2001;697-708.
24. 24. Shimizu H, Ohsaki A, Oh-I S, Okada S, Mori M. A new anorexigenic protein, Nesfatin-1. Peptides. 2009;30:995-8.
25. 25. Stengel A, Goebel M, Yakubov I, Wang L, Witcher D, Coskun T, et al. Identification and characterization of Nesfatin-1 immunoreactivity in endocrine cell types of the rat gastric oxyntic mucosa. Endocrinology. 2009;150:232–8.
26. 26. Gonzalez R, Tiwari A, Unniappan S. Pancreatic beta cells colocalize insulin and proNesfatin immunoreactivity in rodents. Biochem Biophys Res Commun. 2009;381:643–8.
27. 27. Aydin S. The presence of the peptides apelin, ghrelin and Nesfatin-1 in the human breast milk, and the lowering of their levels in patients with gestational diabetes mellitus. Peptides. 2010;31:2236-40.
28. 28. Goebel M, Stengel A, Wang L, Taché Y. Central Nesfatin-1 reduces the nocturnal food intake in mice by reducing meal size and increasing inter-meal intervals. Peptides. 2011;32:36–43.
29. 29. Stengel A, Taché Y. Minireview:Nesfatin-1 an emerging new player in the brain-gut, endocrine, and metabolic axis. Endocrinology. 2011;152:4033–8.
30. 30. Tsuchiya T, Shimizu H, Yamada M, Osaki A, Oh-I S, Ariyama Y et al. Fasting concentrations of Nesfatin-1 are negatively correlated with body mass index in non-obese males. Clin Endocrinol (Oxf). 2010;73:484-90.
31. 31. Nakata M, Manaka K, Yamamoto S, Mori M, Yada T. Nesfatin-1 enhances glucose-induced insulin secretion by promoting Ca2+ influx through L-type channels in mouse islet beta-cells. Endocr J. 2011;58:305–13.
32. 32. Gonzalez R, Reingold BK, Gao X, Gaidhu MP, Tsushima RG, Unniappan S. Nesfatin-1 exerts a direct, glucose-dependent insulinotropic action on mouse islet beta and MIN6 cells. J Endocrinol. 2011;208:9-16.
33. 33. Hofmann T, Stengel A, Ahnis A, Buße P, Elbelt U, Klapp BF. NUCB2/Nesfatin-1 is associated with elevated scores of anxiety in female obese patients. Psychoneuroendocrinology. 2013;38:2502-10.
34. 34. Gunay H, Tutuncu R, Aydin S, Dag E, Abasli D. Decreased plasma Nesfatin-1 levels in patients with generalized anxiety disorder. Psychoneuroendocrinology. 2012;37:1949-53.