Comparison of TIVA and VIMA for Endocrine Stress Response and Anesthesia Characteristics / 대한마취과학회지

BACKGROUND: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). METHODS: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. RESULTS: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. CONCLUSIONS: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia.

Comparison of TIVA and VIMA for Endocrine Stress Response and Anesthesia Characteristics / 대한마취과학회지

BACKGROUND: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). METHODS: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. RESULTS: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. CONCLUSIONS: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia.

Nausea and Vomiting after VIMA with Sevoflurane in Pediatric Patients / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the most common complications after general anesthesia. Sevoflurane is a newer inhalational anesthetic agent and is commonly used in general anesthesia, especially in pediatric patients and outpatients. However, the incidence of PONV after volatile induction and maintenance of anesthesia (VIMA) with sevoflurane in pediatric patients has not been reported in Korea. In this study, the incidence of PONV after VIMA with sevoflurane in pediatric patients was evaluated. METHODS: A total of 251 pediatric patients, scheduled for inguinal surgery, extremity operation and perianal surgery, were selected for the study. None of the pediatric patients was given premedicants, opioids or reversal agents during VIMA. RESULTS: The incidence of PONV after VIMA with sevoflurane in pediatric patients was 9.2%. There were no significant differences in PONV incidence according to the sex or age. PONV commonly occurred immediately after anesthesia, with the incidence of 4.9% in the operating room and 3.2% in the recovery room, respectively. CONCLUSIONS: The VIMA technique with sevoflurane for brief operations could reduce the incidence of PONV but not to zero incidence. Therefore, anesthesiologists should pay attention to the possibility of PONV, and should consider not only the anesthetic methods and agents but also the use of antiemetics, especially in high risk patients.