[The effect of thoracic peridural analgesia on the cortisol and glucose response in surgery of the abdominal aorta]

Abstract

It has been shown that the stress response to lower abdominal surgery can be inhibited by epidural analgesia (EA). But EA seems to have little influence on the stress reaction to major abdominal surgery. The purpose of our study was to find out whether EA is able to diminish the cortisol and glucose response to major transabdominal surgery.

Methods: 31 patients undergoing elective surgery of the abdominal aorta were subdivided at random into 3 different anaesthesia groups: 1. halothane anesthesia, 2. neuroleptanalgesia (NLA) and 3. thoracic EA with bupivacaine (0.5%) in combination with a light general anesthesia. Some patients of each group received an intravenous infusion of 5% glucose. Blood samples were drawn before anesthesia, after intubation, 5 times during surgery and at the end of the operation and were analysed for cortisol and glucose. During the early postoperative period, 1, 2 and 24 h after surgery, only cortisol was measured.

Results: Only the glucose levels of patients who received no carbohydrate-containing infusion fluids were used for evaluation of the stress response. In the halothane group, there was a significant increase of the mean cortisol and glucose levels after the start of surgery. No intraoperative elevations of blood glucose and cortisol were seen in the EA group. Patients of the NLA group showed no hyperglycaemia and only mild elevations of the cortisol levels during the intraoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)