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Propofol/Sufentanil Anesthesia Suppresses the Metabolic and Endocrine Response During, Not After, Lower Abdominal Surgery

2000; Lippincott Williams & Wilkins; Volume: 90; Issue: 2 Linguagem: Inglês

10.1097/00000539-200002000-00039

1526-7598

Thomas Schricker, Franco Carli, Markus Schreiber, Ulrich Wachter, W. Geisser, Ralph Lattermann, Michael Georgieff,

Anesthesia and Pain Management

We investigated the influence of propofol/sufentanil anesthesia on metabolic and endocrine responses during, and immediately after, lower abdominal surgery. Twenty otherwise healthy patients undergoing abdominal hysterectomy for benign myoma received either continuous infusions of propofol supplemented with sufentanil (0.01 μg · kg−1 · min−1, n = 10) or enflurane anesthesia (enflurane, n = 10). Plasma concentrations of glucose, lactate, free fatty acids, triglycerides, insulin, glucagon, cortisol, epinephrine, and norepinephrine were measured before, during, and 2 h after surgery. Pre- and postoperative endogenous glucose production (Ra glucose) was analyzed by an isotope dilution technique by using [6,6-2H2] glucose. Propofol/sufentanil anesthesia prevented the increase in plasma cortisol and catecholamine concentrations and attenuated the hyperglycemic response during surgery without showing any difference after the operation. Mediated through a higher glucagon/insulin quotient (propofol/sufentanil 15 ± 7 versus enflurane 8 ± 4 pg/μU, P < 0.05), the Ra glucose postoperatively increased more in the propofol/sufentanil than in the enflurane group (propofol/sufentanil 15.6 ± 2.0 versus enflurane 13.4 ± 2.2 μmol · kg−1 · min−1, P < 0.05). Implications The concept of stress-free anesthesia using propofol combined with sufentanil is valid only during surgery. The metabolic endocrine stress response 2 h after the operation is more pronounced than after inhaled anesthesia.