Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Controlled Clinical Trial
. 2014 Oct 6:20:1833-40.
doi: 10.12659/MSM.890981.

Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients

Snezana B Milosavljevic  1 , Aleksandar P Pavlovic  2 , Sladjana V Trpkovic  2 , Aleksandra N Ilić  3 , Ana D Sekulic  4
Affiliations
Controlled Clinical Trial

Influence of spinal and general anesthesia on the metabolic, hormonal, and hemodynamic response in elective surgical patients

Snezana B Milosavljevic et al. Med Sci Monit. .

Abstract

Background: The aim of the study was to determine the significance of spinal anesthesia in the suppression of the metabolic, hormonal, and hemodynamic response to surgical stress in elective surgical patients compared to general anesthesia.

Material and methods: The study was clinical, prospective, and controlled and it involved 2 groups of patients (the spinal and the general anesthesia group) who underwent the same surgery. We monitored the metabolic and hormonal response to perioperative stress based on serum cortisol level and glycemia. We also examined how the different techniques of anesthesia affect these hemodynamic parameters: systolic arterial pressure (AP), diastolic AP, heart rate (HR), and arterial oxygen saturation (SpO2). These parameters were measured before induction on anesthesia (T1), 30 min after the surgical incisions (T2), 1 h postoperatively (T3) and 24 h after surgery (T4).

Results: Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). Glycemia was significantly higher in the general anesthesia group (p<0.05). There was a statistically significant, positive correlation between serum cortisol levels and glycemia at all times observed (p<0.01). Systolic and diastolic AP did not differ significantly between the groups (p=0.191, p=0.101). The HR was significantly higher in the general anesthesia group (p<0.01). SpO2 values did not differ significantly between the groups (p=0.081).

Conclusions: Based on metabolic, hormonal, and hemodynamic responses, spinal anesthesia proved more effective than general anesthesia in suppressing stress response in elective surgical patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Comparison of serum cortisol levels between the groups in the observed period. Serum cortisol levels were significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.01). In the observed time period serum cortisol levels are statistically significantly different (p<0.01) with a significant linear trend of decline of serum cortisol levels (p<0.01) and a significant quadratic trend of increase in serum cortisol levels at T2, which in the further course of the period decreases in value (p<0.01). Changes in serum cortisol levels are statistically significantly different over time for both groups (p<0.01)
Figure 2
Figure 2
Comparison of glycemia between groups during the observed period. Glycemia was significantly higher in the general anesthesia group compared to the spinal anesthesia group (p<0.05). During the observed period serum glucose levels differ significantly (p<0.01) with a significant linear trend of decrease in glycemia (p<0.01) and a significant quadratic trend of increase in serum cortisol levels at T2, which in the further course of the period decreased in values (p<0.01). Glycemia was significantly lower in the spinal anesthesia group at times T2 and T3 (both p<0.05), while the difference was not statistically significant at the times T1 and T4 (both p>0.05). Changes in glycemia did not differ significantly over time for both groups (p=0.60).
Figure 3
Figure 3
Comparison of systolic and diastolic AP between the groups during the observed period. Systolic AP was significantly higher in the general anesthesia group at times T2, T3 and T4 (p<0.05), while the difference was not statistically significant at time T1 (p=0.303). Diastolic AP in the general anesthesia group was significantly lower at time T1, while at times T2 and T3 diastolic AP is significantly higher compared to the spinal anesthesia group (both p<0.01). The difference in diastolic AP measurements was not statistically significant at time T4 (p=0.246). Changes in values of systolic and diastolic AP are statistically significant in the observed time for both groups (p<0.01). (* p<0.01 or p<0.05).
Figure 4
Figure 4
Comparison of the HR and SpO2 values between groups during the observed period. During the observed period the HR is significantly different (p<0.01) with a significant linear trend of depreciation of the HR (p<0.01) but there was no significant difference in the fluctuations of the values at different points of measurement (p=0.917). Changes in HR do not vary significantly over time for both group (p=0.456). SpO2 values do not differ significantly between the groups (p=0.081) or in the observed period (p=0.475).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lalevic i sar. Anesteziologija. Zavod za udzbenike i nastavna sredstva; Beograd: 1999. pp. 4–5. [in Serbian]
    1. Sapolsky R, Romero M, Muunck A. How do glucocorticoides influence stress responses? Integrating, permissive, suppressive, stimulatory and preparative actions. Endocrine Rev. 2000;21(1):55–89. - PubMed
    1. Guyton A, Hall JE. Medicinska fiziologija. Savremena administracija; Beograd: 2008. [in Serbian]
    1. Antanaskovic S, Stojanovic-Ilic M, Milic S, Dukic M. Neuroendokrinoloski i metabolicki odgovor bolesnika na preoperativni stres. Medicina Danas. 2012;11(7–9):207–11. [in Serbian]
    1. Desborough JP. The stress response to trauma and surgery. Br J Anaesth. 2000;85(1):109–17. - PubMed

Publication types