ABSTRACT
BACKGROUND: Hormonal and metabolic changes following surgery are markers of the stress response to surgery. We compared hemodynamic parameters and stress response markers (glucose, cortisol, and C-reactive protein) in two groups of patients receiving either propofol or isoflurane combined with remifentanil for maintenance of anesthesia. METHODS: We randomly assigned 100 women (ASA I-II) scheduled for diagnostic gynecologic laparoscopy to receive either isoflurane (0.8% end-tidal) or propofol (100 mg/kg/min) in addition to remifentanil (0.25 mg/ kg/min). Heart rate and mean arterial pressure were recorded after induction, 30 seconds after intubation, at four time points after incision, and 60 min after surgery. Serum C-reactive protein, cortisol and glucose concentrations were measured before induction, one hour after incision, and one hour after surgery. RESULTS: After induction, heart rate decreased significantly from baseline in both groups, and remained below baseline until the end of surgery. Mean arterial pressure also decreased significantly in both groups. C-reactive protein levels were not significantly different between groups. In the propofol group, cortisol decreased significantly one hour after incision, but increased in the isoflurane group. Glucose increased significantly in both groups, but was significantly lower in the propofol group one hour after the incision and one hour after surgery. CONCLUSION: An anesthetic regimen combining propofol and remifentanil attenuates two indicators of the stress response more efficiently than a isoflurane - remifentanil combination.
Subject(s)
Anesthetics, Combined/pharmacology , Gynecologic Surgical Procedures , Isoflurane/pharmacology , Piperidines/pharmacology , Propofol/pharmacology , Stress, Physiological/drug effects , Adult , Anesthetics, Combined/blood , Anesthetics, Inhalation/blood , Anesthetics, Inhalation/pharmacology , Anesthetics, Intravenous/blood , Anesthetics, Intravenous/pharmacology , Arterial Pressure/drug effects , Biomarkers/blood , Blood Glucose/drug effects , C-Reactive Protein , Female , Heart Rate/drug effects , Hemodynamics/drug effects , Humans , Hydrocortisone/blood , Isoflurane/blood , Piperidines/blood , Propofol/blood , RemifentanilABSTRACT
Two patients, each with a large rectovaginal fistula, were managed successfully by intravenous feeding and surgical repair of their fistulae. Intravenous feeding eliminated the need for food from the gastrointestinal tract, thus minimizing the fecal flow. Both fistulae healed following surgical repair. Neither patient required a diverting colostomy.
