ABSTRACT
BACKGROUND: Inevitable prolonged fasting time before surgery leads to inflammatory reactions, surgery-related stress response, and consequently unfavorable outcomes; thus, developing strategies to mitigate these consequences is crucial. OBJECTIVES: In this study, we evaluated the effect of ascorbic acid on stress response reduction in abdominal hysterectomy following prolonged fasting time. METHODS: Eligible women candidates for abdominal hysterectomy following prolonged fasting time were enrolled in the study and divided into 2 groups of vitamin C [group C; 1 g intravenously (IV) before surgery] and placebo (group P). Before induction of anesthesia, C-reactive protein (CRP), mean arterial pressure (MAP), heart rate (HR), and blood sugar (BS) were measured and compared between the 2 groups at 4-point times, 24 and 48 hours immediately after extubation. RESULTS: Finally, the data of 80 patients were included for the final analysis. A statistically significant difference was observed between the 2 groups in terms of CRP and BS values in T1 CRP serum levels; at the end of the study, CRP values were 0.5 ± 0.55 and 0.92 ± 0.69 in groups C and P, respectively (P = 0.012), and BS levels were 124.12 ± 18.11 and 152.0 ± 17.36 in groups C and P, respectively (P = 0.0001). However, this significant difference was not observed at T2 regarding CRP (P = 0.145) and BS (P = 0.135), as well as at T3 regarding CRP (P = 0.282) and BS (P = 0.213). However, according to both CRP and BS values, the trend of changes from T0 to T3 was significant in the 2 groups (P < 0.0001). Hemodynamic parameters were not significantly different between the 2 groups. No adverse event was reported in the 2 groups. CONCLUSIONS: We found that ascorbic acid could induce short-term positive effects in abdominal hysterectomy following prolonged fasting time. Obviously, the optimal dosage, timing, and specific cases that benefit the most from this intervention should be investigated.
ABSTRACT
BACKGROUND: Intraoperative stress may evoke various changes in hormonal secretion and autonomic nervous system activity. We designed this study to investigate the effect of combined spinal-epidural anesthesia on stress hormone responses. METHODS: Thirty women more than 60 years of age, undergoing bilateral total knee replacement surgery were studied. Patients were randomized to receive either general anesthesia (group I), or combined spinal-epidural anesthesia (group II). Blood samples were obtained immediately before anesthesia induction, immediately after skin incision, after first knee prosthesis insertion, and end of operation, immediately for measurement of cortisol, epinephrine, and norepinephrine. RESULTS: The plasma concentration of cortisol, epinephrine and norepinephrine were significantly lower in group II after the prosthesis insertion and at the end of operation, immediately. The plasma concentration of cortisol was significantly higher than basal values in both of two groups through the surgery. CONCLUSIONS: Combined spinal-epidural anesthesia has the blocking effect of releasing catecholamine during total knee replacement surgery and immediately after the surgery. The effect of combined spinal-epidural anesthesia on stress responses during total knee replacement is better than that of general anesthesia.
ABSTRACT
BACKGROUND: Intraoperative stress may evoke various changes in hormonal secretion and autonomic nervous system activity. We designed this study to investigate the effect of combined spinal-epidural anesthesia on stress hormone responses. METHODS: Thirty women more than 60 years of age, undergoing bilateral total knee replacement surgery were studied. Patients were randomized to receive either general anesthesia (group I), or combined spinal-epidural anesthesia (group II). Blood samples were obtained immediately before anesthesia induction, immediately after skin incision, after first knee prosthesis insertion, and end of operation, immediately for measurement of cortisol, epinephrine, and norepinephrine. RESULTS: The plasma concentration of cortisol, epinephrine and norepinephrine were significantly lower in group II after the prosthesis insertion and at the end of operation, immediately. The plasma concentration of cortisol was significantly higher than basal values in both of two groups through the surgery. CONCLUSIONS: Combined spinal-epidural anesthesia has the blocking effect of releasing catecholamine during total knee replacement surgery and immediately after the surgery. The effect of combined spinal-epidural anesthesia on stress responses during total knee replacement is better than that of general anesthesia.
