Effects of Spinal and Inhalational Anesthesia on Plasma Caticholamines.
10.4097/kjae.1991.24.2.339
- Author:
Hak Ryul KIM
1
;
Jae Kyu CHEUN
Author Information
1. Department of Anesthesiology, Keimyung University School of Medicine, Taegu, Korea.
- Publication Type:Original Article
- Keywords:
Spinal anesthesia;
Lidocaine;
Plasma catecholamine
- MeSH:
Anesthesia*;
Anesthesia, General;
Anesthesia, Inhalation;
Anesthesia, Spinal;
Arterial Pressure;
Blood Pressure;
Blood Pressure Monitors;
Catecholamines;
Epinephrine;
Halothane;
Humans;
Intubation, Intratracheal;
Lidocaine;
Muscle Relaxation;
Norepinephrine;
Pancuronium;
Plasma*;
Postoperative Period;
Premedication;
Recovery Room;
Sodium;
Succinylcholine;
Surgical Procedures, Elective;
Thiopental;
Veins
- From:Korean Journal of Anesthesiology
1991;24(2):339-348
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Surgery represents a noxious stimulus to the body, which responds to the injury in the form of an endocrine metabolic reaction. This stress responsehas usually been considered to be a homeostatic defence mechanism by which the body protects itself against injury. This study was primarily undertaken to observe the modulation of stress response to the surgical stimuli under the effects of general and spinal anesthesia by measuring endogenous catecholamines. Fifteen pateints scheuled for elective surgical procedures on the lower half of the body were divided into two group: general and spinal anesthesia groups. No premedication was given to any patient. After the patient was laid down the surgical table, intravenous line was placed and secured in an antecuhital vein for maintenance of fluid and obtaining blood samples. After the intravenous cathether was inserted and a 10-minute rest period was allowed for reassurance, the first baseline sample was obtained for measurement of catecholamines and then anesthesia was induced. .General anesthesia group: Anesthesia in five patients was induced with sodium thiopental (5 mg/ kg), succinylcholine (1 mg/kg) followed by endotracheal intubation and was maintained with halothane, N2O and muscle relaxation using pancuronium. Spinal anesthesia group: Spinal anesthesia in ten patients was performed in a sitting position at L3-L4 intervertebral space using lidocaine 50-150 mg. The anesthesia level was determined by a pinprick test. Subsequent samples were obtained at 30 minutes after the surgical incision and in the recovery room at least 60 minutes after the discontiuation of inhalational anesthesia or after recovery of senastion and motor function of the lower extremites. Mean arterial pressure was measurd by a noninvasive automatic blood pressure monitor. Plasma epinephrine and norepinephrine were measured by Peuler and Johnson radioenzymatic method. The results are summerized as follows: Inhalation anesthesia group: Plasma norepinephrine was increased during surgery and epinephrine was increased during the postoperative recovery period. Spinal anesthesia group: Plasma norepinephrine and epinephrine were not increased during the intra and postoperative periods. High spinal anesthesia resulted in a suppression of both plasma norepinephrine, epinephrine with a fall of mean arterial pressure but no changes of norepinephrine, epinephrine, or mean arterial pressure were observed in the patients receiving low spinal anesthesia. There was a relationship between the sensory dermatome anesthesia level and changes of both plasma norepinephrine (r=0.748, P<0.01)and epinephrine (r=0.667, P<0.05). There is a relationship between changes of blood pressure and plasma norepinephrine levels during spinal anesthesia and inhalational anesthesia (r=0.827, p<0.01). The effect of spinal anesthesia on adrenergic tone depends on the level of anesthesia. The catecholamine responses to surgical stress were prevented by low spinal anesthesia which had no supression of efferent adrenergic tone. Therefore, low spinal anesthesia maybe useful to prevent adrenergic responses to surgical stress in high-risk patients scheduled for surgery on the lower half of the body.
