Comparison of stress hormone response, interleukin-6 and anaesthetic characteristics of two anaesthetic techniques: volatile induction and maintenance of anaesthesia using sevoflurane versus total intravenous anaesthesia using propofol and remifentanil.

This prospective randomized study compared the effects of two types of anaesthesia on peri-operative anaesthetic profiles from induction to recovery and on immunological and neurohormonal responses to anaesthesia and surgical stress. Forty patients were assigned to undergo either volatile induction and maintenance of anaesthesia (VIMA) with sevoflurane or total intravenous anaesthesia (TIVA) with propofol and remifentanil. Plasma adrenaline, noradrenaline, cortisol, glucose and interleukin-6 (IL-6) levels were measured at baseline, induction, incision and extubation. TIVA produced a significantly lower intubation score, shorter time to intubation and faster waking time than VIMA, but recovery profiles did not differ. Adrenaline, noradrenaline, cortisol and glucose levels were significantly lower with TIVA than VIMA, but there was no difference in IL-6 levels between the two groups. TIVA with propofol and remifentanil may be preferable to VIMA with sevoflurane alone because it leads to smoother, more rapid induction, more rapid awakening and lower stress responses to surgical stimuli.

Comparison of three warming devices for the prevention of core hypothermia and post-anaesthesia shivering.

The efficacy of forced air warming with a surgical access blanket in preventing a decrease in core temperature during anaesthesia and post-anaesthesia shivering (PAS) was compared with two widely used interventions comprising forced air warming combined with an upper body blanket, and a circulating water mattress, in a prospective, randomized double-blind study. A total of 90 patients undergoing total abdominal hysterectomy were studied, 30 in each group. Core temperature was measured 15, 30, 45, 60, 90 and 120 min after induction of anaesthesia. PAS was evaluated every 5 min after emergence from anaesthesia over a period of 1 h. Core temperature fell in all three groups compared with the baseline, but forced air warming using a surgical access blanket was more effective than the other warming methods in ameliorating the temperature decrease. The surgical access blanket was also superior to the circulating water mattress in reducing PAS.