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Surgical Endoscopy

Published in:

01-03-2013

The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery

Authors: Seokyung Shin, Sun Joon Bai, Koon Ho Rha, Yun So, Young Jun Oh

Published in: Surgical Endoscopy | Issue 3/2013

Abstract

Background

Pneumoperitoneum during laparoscopic surgery is known to affect visceral blood flow and result in oxidative stress. Whether epidural anesthesia will effectively reduce visceral ischemia and oxidative stress by blocking the sympathetic nervous system (SNS) during laparoscopic surgery has not been proven.

Methods

Forty-five patients who were to undergo robot-assisted laparoscopic prostatectomy were randomly assigned to the combined general–epidural anesthesia group (group GE, n = 22) or to the general anesthesia group (group G, n = 23). Blood pressure, heart rate, and the balance between sympathetic and parasympathetic nervous system activity as measured by heart rate variability were recorded at 10 min after induction of anesthesia (T1), 60 (T2) and 120 (T3) min after intra-abdominal CO₂ insufflation, and 10 min after returning the patient to the supine position following CO₂ exsufflation (T4). Arterial blood gas analysis and blood sampling for measurements of nitrite (NO²⁻) and malondialdehyde (MDA) were performed at all time points.

Results

Intraoperative mean blood pressure was significantly lower in group GE compared with group G. The low-frequency to high-frequency ratio was significantly increased after induction of pneumoperitoneum in group G but was unchanged in group GE. Plasma levels of nitrite decreased after pneumoperitoneum induction in group G while there was no change in group GE. A significant increase in MDA levels was seen in group G after pneumoperitoneum induction and were higher than group GE at T3 and T4. The 24-h urine output was higher in group GE than in group G on POD 1. The 24-h CrCl was higher in group GE on POD 1 but was not different between groups on POD 2.

Conclusions

Combined epidural and general anesthesia effectively blocks SNS stimulation during laparoscopic surgery and reduces NO inactivation and oxidative stress.

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Title: The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery
Authors: Seokyung Shin
Sun Joon Bai
Koon Ho Rha
Yun So
Young Jun Oh
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 3/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2536-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effects of combined epidural and general anesthesia on the autonomic nervous system and bioavailability of nitric oxide in patients undergoing laparoscopic pelvic surgery

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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