The effects of general anesthetic agents on stress hormones of patients undergoing abdominal hysterectomy

Introduction: The stress response to surgery and anesthesia, which is modulated by several factors including magnitude of the injury and type of anesthesia, causes endocrinological and metabolic changes.Objective: The aim of this study was to compare the effects of desflurane-dexmedetomidine, sevoflurane- dexmedetomidine and propofol-remifentanil used with the guidance of BIS, on stress response and heamodynamic parameters.Materials and Methods: Forty-five ASA I/II women undergoing total abdominal hysterectomy were included to the study. Any woman who had liver disease, renal, endocrinological, or cardiovascular disorders were excluded from the study. Women were also not eligible if they used any medications which may affect the liver tests and/or autonomic nerves system. Patients were randomly allocated into three groups. Patients assigned to Group D (n=15) received desflurane- dexmedetomidine; while patients allocated to Group S (n=15) received sevoflurane- dexmedetomidine and Group T (n=15) received propofol-remifentanil. The concentration of anesthestic agent was adjusted so that the BIS remained between 40 and 60. Anesthesia was induced with intravenous bolus administration of 1-1,5 mg?kg-1 propofol and dexmedetomidine 1µg?kg-1 infusion in Groups D and S; and with 1-1.5mg?kg-1 propofol and 1µg?kg-1 remifentanil administration in Group T. Then vecuronium 0,1 mg?kg-1 was administered intravenously to facilitate tracheal intubation. Anesthesia was maintained with desflurane with 50% oxygen in 50% air and infusion of 0,2-0,7µg?kg-1?h-1 dexmedetomidine in Group D; sevoflurane with 50% oxygen in 50% air and infusion of 0,2-0,7µg?kg-1?h-1 dexmedetomidine in Group S; with propofol-remifentanil infusion in Group T. Any reaction including straining, coughing, spontaneous movement of extremities, lacrimation was recorded during the intubation. Hearth rate, systolic and diastolic blood pressure, SpO2, end-tidal carbondioxide and bispectral index were recorded at baseline and at every minute for the first five minutes after the anesthetic induction and at five minute intervals afterward. Serum glucose and cortisol levels were recorded before, during and at the end of surgery and 24 hours after surgery.Results: The alterations in levels of serum glucose and cortisol in response to both intubation and surgical incision were significantly elevated in Group D and Group S than Group T (p<0.05). Similarly, the hemodynamic parameters demonstrated significant changes in Group D and Group S with compare Group T (p<0.05). Straining was observed in one patient from the Group S, in 3 patients from Group D and Group S during the intubation. Lacrimation was noted in 13, 12, and 3 patients from the Groups D, S, and T, respectively. On the other hand, an extremity movement was observed in 2 and 4 patients in the Groups D and S, respectively.