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Research of a hormone of stress-cortisol and concentration of blood sugar for an estimation efficiency anesthesia
Yusupov Anvar Sabirdjanovich, Tashkent Pediatric Medical Institute, Department of Anesthesiology, PhD, MD E-mail: [email protected] Agzamhodjaev Talat Saidalimovich, Department of Anesthesiology, PhD, MD Fayziev Otabek Yakupdjanovich, Department of Anesthesiology, MD E-mail: [email protected] Mamatkulov Isfandiyor Abdurahmanovich, Department of Anesthesiology, MD E-mail: [email protected] Avazov Jasurbek Husinovich, postgraduate student, the Faculty of Anesthesiology E-mail: [email protected]
Research of a hormone of stress-cortisol and concentration of blood sugar for an estimation efficiency anesthesia
Abstract: Aim of investigation: To study changing of concentration of cortisol and concentration of glucose of blood for the evaluation different mode of anaesthetic manuals at children. 64 acquired patients undergoing surgical correction with mean age 2-14 subsequently was included. MBP, HR, concentration of cortisol and sugar of blood were investigated. We concluded: nubain-propofol versus nubain — valium — ketamine general anesthesia provide stable hemodynamic profile during the surgery.
Keywords; nubain, anesthesia, ketamine, valium, propofol, cortisol.
Blood analysis to hormones detects in wide application at diagnostics in such regions of medicine like a endocrinology, oncology, gynaecology, urology, androl-ogy, ophthalmology, neuropathology, anesthesiology and many other ways [1, 24-36]. Stress reactions of organism in time of operation and anaesthesia accompanies with rising concentration of adrenal gland, especially adrenalin, noradrenalin and cortisol. Cortisol takes part in regulation many metabolic (biochemical) processes and plays key roles in defence reaction to stress and starvation. In time of starvation, for example, it supplies maintenance of correct level of glucose of blood, but at the psychic or operative [surgical] shock resists to falling blood pressure to dangerous levels [2, 12-13]. Integrated study of functional status of hemodynamics, activity of stresses-hormones during anesthesia and operation allows to judge level of efficiency anaesthetic protection of organism against operative trauma in condition of this or that kind of anaesthesia [3, 131-146; 5, 28-30].
Questions of intraoperative quantitative changes of showings ofstress hormone are elucidated in literatures not enough. Thereby, last years have led the researches purposely to comprehensive study a reaction of adrenal hormone on surgical stress by level ofthem in blood plasma [4, 159].
Aim ofwork: To study changing of concentration of cortisol and concentration of glucose ofblood for the evaluation different mode of anesthetic manuals at children.
Material and methods: Researches were led with 64 children at the age of 2 to 14 who were forthcoming on surgery about disease and congenital malformation. Status of children correspond to ASA I - II class. Until 10 minute to operation to all patients accomplished premedication: Atropine (0.1 % — 0.01mg/kg) and valium (0.5 % — 0.3 mg/kg) by intramuscularly.
For supplying anesthetic safeguards applied two methods of combined anesthesia with using nubain:
1) Combined anesthesia with using nubain (2 mg/kg) and propofol (3mg/kg).
2) Combined anesthesia with using nubain (3 mg/kg) and valium (0.4 mg/kg) with subnarcotic dose of ketamine (1 mg/kg). Concentration of cortisol ofblood was determined by applying immunoflurecence methods with using devises of “Human" (Germany).
Results: Concentration of glucose of blood was determined before and after surgical period. Before applying anesthetic method by using nubain combination and valium with ketamine, concentration of glucose of blood was consisted 3.96 ± 0.09 mmol/l (Chart 1).
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Section 3. Medical science
Chart 1. Changing concentration of glucose of blood (mmol/L) in time of applying combined anesthesia with nubain at children
After operations registered unreliable decreasing concentration of glucose to 2.53 %, which was consisted 3.86 ± 0.14 mmol/l.
Before applying anaesthetic method by using nubain combination with propofol concentration of glucose of blood was consisted 4.06 ± 0.11 mmol/l. Registered
decreasing of concentration of this showings after operations till 4.43 %, which was consisted 3.88 ± 0.1 mmol/l.
Detection content of adrenal hormone (cortisol) and concentration of glucose of blood of children at different stages of combined anesthesia by using nubain and valium with subnarcotic dose of ketamine presented at table 1.
Table 1. - Changing concentration of cortisol at different stages of combined anesthesia by using nubain and valium with ketamine at children
Mode of anesthetic method Normal concentration of cortisol (mg/ml) Concentration of cortisol (mg/ml) at stage of anesthesia
Initial period Induction period Period of maintenance anesthesia Awakening period
Nubain + valium and ketamine 50-250 169.28 ± 4.63 185.06 ± 5.47* 175.41 ± 6.50 168.47 ± 4.59
Nubain + propofol 50-250 167.90 ± 3.52 177.04 ± 3.63 173.15 ± 2.08 166.54 ± 1.61
Note: * — reliable difference of showings against the initial level (p < 0,05).
Nubaine + propofol
Chart 2. Changing concentration of cortisol at different stages of combined anesthesia with using nubain at children
Note: * — reliable difference of showings against the initial level (р < 0,05).
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Research of a hormone of stress-cortisol and concentration of blood sugar for an estimation efficiency anesthesia
At the induction period of anaesthesia as a premedication observed reliable increasing concentration of cortisol till 9.32 %.
In most traumatic time of operation — in period of maintaining anesthesia concentration of cortisol also had tendency to decreasing til 5.21 %, but comparing with initial period registered increasing the concentration of cortisol till 3.62 %.
At the end of operation — at the period of maintaining anesthesia observed decreasing concentration of cortisol till 3.96 %, but comparing with initial period till 0.48 %. Thereby, over the period of operation and anesthesia level of stress-hormone of blood was characterized to relative stability, changing variation was in the range of norm.
Facts of researches of content of stress-hormone (cortisol) of cortex of adrenal gland in time of different mode of anaesthesia by using nubain at children presented at chart 2 and table 1. According to this facts, at
the induction period, during premedication sleep content of cortisol of blood characterized to rising tendency to 5.44 % as compared with reference value.
During period of maintaining anesthesia, in most traumatic stages of operation target hormone decreased to 2.20 % than induction period, but as compared with reference value detected rising to 3.13 %.
At the end of operation observed reliable decreasing concentration of cortisol to 3.82 %. As compared them with reference value concentration of cortisol decreased only to 0.81 %, it means showings were in the range of norm.
Summary: In main stages of general anesthesia by using nubain combined with ketamine and valium, so with the propofol at children who were detected decreasing concentration of stress-hormone (cortisol) of blood (changes in the range of norm), testified supplying adequate protection children’s organism against operative trauma without signs of activation of hormonal regulation.
References:
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3. Dronov A. F., Poddubniy I. V., Kotlobovsky V. I. Endoscopic surgery in chidren. - Moscow. Medical - 2002. -P. 131-146.
4. Grinevich V. V. Fundamentals of interaction of the nervous, endocrine and immune systems./Symposium, 2004. - P. 159.
5. Kovalev S. V., Koryachkin V. A. Correction of changes of hemodynamics during the operation of aortafemoral shunting in case of combined epidural anesthesia.//Anesth. and resuscitate. - 2007. - № 5. - P. 28-30.
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