Cortisol and Insulin Levels during Major Gynaecological Operations: The influence of Two Anaesthetic Techniques

BACKGROUND: Metabolic and hormonal changes are noticed within the first few hours after surgical injury. These changes are influenced by the intensity, duration, type of injury, and the anaesthetic techniques.AIM: To investigate the effects of anaesthesia on cortisol, insulin and glucose concentrations during major gynaecological surgeries.METHODS: Forty patients were randomly allotted to receive either balanced general anaesthesia (n=20) or combined spinal epidural anaesthesia extending from T5 to S5 (n=20). Blood samples were collected for cortisol and glucose at preinduction, 1, 3 and 4 hours, and for insulin at preinduction and 24 hours after incision.RESULTS: The mean cortisol concentration was significantly lower 4 hours after incision with combined spinal epidural anaesthesia (19.96 ± 11.32) μg/dl than with balanced general anaesthesia (38.94 ± 10.6) μg/dl, p = 0.018. The mean insulin concentration, 24 hours after incision decreased with combined spinal epidural anaesthesia, but increased with balanced general anaesthesia p = 0.403. The mean glucose concentrations were significantly lower with combined spinal epidural anaesthesia than with balanced general anaesthesia during the 4 hour study period p ≤ 0.05.CONCLUSION: combined spinal epidural anaesthesia extending from T5 to S5 resulted in lower cortisol, insulin and glucose concentrations during major gynaecological surgeries. This may be of benefit in patients scheduled for surgical operations below the umbilicus.

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A comparative study of combined spinal epidural anaesthesia and general anaesthesia in patients undergoing percutaneous nephrolithotomy

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20162614 ◽

2016 ◽

pp. 3760-3767

Author(s):

Nilam Virkar ◽

Geeta Patkar ◽

R. Rohit ◽

Bharati Tendolkar

Keyword(s):

Comparative Study ◽

General Anaesthesia ◽

Percutaneous Nephrolithotomy ◽

Epidural Anaesthesia ◽

Combined Spinal Epidural ◽

Spinal Epidural

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COMPARISON OF EFFICACY OF COMBINED SPINAL-EPIDURAL ANAESTHESIA WITH GENERAL ANAESTHESIA IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY

International Journal of Advanced Research ◽

10.21474/ijar01/11621 ◽

2020 ◽

Vol 8 (8) ◽

pp. 1347-1354

Author(s):

Sunny Kumar ◽

◽

Kalpana Kulkarni

Keyword(s):

Laparoscopic Cholecystectomy ◽

General Anaesthesia ◽

Epidural Anaesthesia ◽

Combined Spinal Epidural ◽

Spinal Epidural

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General anaesthesia versus combined spinal epidural anaesthesia in the presence of mild to moderate pericardial effusion: A study of volunteers undergoing caesarean section

Egyptian Journal of Anaesthesia ◽

10.1016/j.egja.2012.08.005 ◽

2013 ◽

Vol 29 (1) ◽

pp. 19-24

Author(s):

Ahmed S. Elgebaly ◽

Tark Elhawary

Keyword(s):

Pericardial Effusion ◽

Caesarean Section ◽

General Anaesthesia ◽

Epidural Anaesthesia ◽

Combined Spinal Epidural ◽

Spinal Epidural

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Comparison of effect of isobaric bupivacaine vs hyperbaric bupivacaine on haemodynamic variables in thorcic combined spinal epidural anaesthesia for laparoscopic cholecystectomies

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20184056 ◽

2018 ◽

Vol 6 (10) ◽

pp. 3413

Author(s):

Loveleen Kour ◽

Kuldip C. Gupta

Keyword(s):

General Anaesthesia ◽

Spinal Anaesthesia ◽

Epidural Anaesthesia ◽

Regional Anaesthesia ◽

Hyperbaric Bupivacaine ◽

Combined Spinal Epidural ◽

Group I ◽

Operative Complications ◽

Lumbar Spinal ◽

Spinal Epidural

Background: Regional anaesthesia has always been an attractive option for laparoscopic surgeries in patients who are not fit for general anaesthesia. Also, regional anaesthesia has certain advantages over general anaesthesia like lesser oropharyngeal morbidity, lesser blood loss and decreased chances of thrombosis. Lumbar spinal anaesthesia has been synonymous with the term regional anaesthesia for laparoscopic surgeries for quite some time now. In the light of recent works by Imbelloni and Zundert, thoracic spinal anaesthesia has been shown to be a promising alternative not only for healthy patients but for high risk patients as well. Baricity defines the density of the drug with respect to CSF density. This undoubtedly makes it is one of the most important factors that influence drug distribution in the subarachnoid space. Drugs of differing baricities have been studied previously in lumbar spinal anaesthesia. We aimed at studying the behaviour of isobaric and hyperbaric bupivacaine using a different approach which in this study was thoracic combined spinal epidural anaesthesia. Authors evaluated the haemodynamic changes as well as neurological and any other post operative complications that occurred in any of the patients.Methods: There were 60 ASA I and II patients undergoing elective laparoscopic cholecystectomy who were chosen for this study. They were randomly divided into two equal groups - group I and group H. Thoracic combined spinal epidural anaesthesia (CSE) was performed at T9-T10 / T10-T11 interspace. Patients in group I received 1.5ml of isobaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl and group H patients were given 1.5ml of hyperbaric bupivacaine 0.5% (5mg/ml) + 25µg (0.5ml) of fentanyl.Results: There was no significant difference among the haemodynamic variables between the two groups and no neurological complication was seen in any patient.Conclusions: Thoracic combined spinal epidural anaesthesia allows haemodynamic stability in laparoscopic cholecystectomies with minimal neurological and post operative complications irrespective of baricity of the drug used.

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