Influence of Spinal and General Anesthesia on the Metabolic, Hormonal, and Hemodynamic Response in Elective Surgical Patients
Snezana B. Milosavljevic, Aleksandar P. Pavlovic, Sladjana V. Trpkovic, Aleksandra N. Ilić, Ana D. Sekulic
Department of Surgery, General Hospital, Kosovska Mitrovica, Serbia
Med Sci Monit 2014; 20:1833-1840
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.
Keywords: Anesthesia, Spinal, Anesthesia, General, Adult, Elective Surgical Procedures, Hemodynamics, Hydrocortisone - blood, Metabolism, Prospective Studies