Effects of epidural-and-general anesthesia combined versus general anesthesia during laparoscopic adrenalectomy.

摘要

Laparoscopic approach is increasingly performed for functional adrenal tumor resections. The aim of this study was to compare general anesthesia and general anesthesia combined with epidural anesthesia for laparoscopic adrenalectomy. In our study, we planned to examine hemodynamic changes (heart rate, systolic, diastolic, and mean pressures) and quantity of adrenocorticotropic hormone, adrenaline, noradrenaline, cortisol, and aldosterone in laparoscopic adrenalectomies under general anesthesia with or without epidural anesthesia. All patients were operated by the same surgical team. With increased experience of the surgical team, the duration of surgery decreased. In parallel with decreased duration of surgery, pneumoperitoneum and undesirable effects also decreased. Nine patients with Conn syndrome, 21 patients with Cushing syndrome, and 2 patients with pheochromocytoma were included in both groups. Thirty-two laparoscopic adrenalectomies for functional adrenal tumors were performed. Sixteen patients who received general anesthesia without epidural anesthesia were compared with 16 patients who received general anesthesia combined with epidural anesthesia. Hemodynamic data, arterial blood gases, and adrenal gland hormones were recorded. Heart rate, systolic blood pressure, and diastolic blood pressure were recorded before anesthesia induction, after insufflation, before adrenalectomy, and after adrenalectomy. Arterial blood gases, adrenocorticotropic hormone (ACTH), cortisol, adrenaline, noradrenaline and aldosterone were recorded before anesthesia induction, after adrenalectomy, and after surgery. Heart rate varied between 68.5 and 84 bpm in general anesthesia group and between 63.5 and 87 bpm in general+epidural anesthesia group. Blood pressure measurements were 154 to 122.5/88.5 to 75 mm Hg in general anesthesia and 149 to 100/86 to 70 mm Hg in general+epidural anesthesia. ACTH was 10.3 to 106.25 in general anesthesia and 17.6 to 104.5 in general+epidural anesthesia. Cortisol was 16.1 to 23.2 microg/dL in general anesthesia and 16.4 to 24.3 microg/dL in general+epidural anesthesia. Aldosterone was 163.3 to 285.2 ng/dL in general anesthesia and 215 to 440 ng/dL in general+epidural anesthesia. There was no significant difference in hemodynamic parameters, ACTH, cortisol, adrenaline, and noradrenaline levels between the 2 groups. Aldosterone levels were higher in general+epidural anesthesia group. The results of our study suggest that epidural anesthesia in addition to general anesthesia in patients with functional adrenal tumors undergoing laparoscopic adrenalectomy might be an effective and safe method to prevent the fluctuations in hormone levels.