Effect of additional general anesthesia with propofol, midazolam or sevoflurane on stress hormone levels in hysterectomy patients, receiving epidural anesthesia.

Abstract

Hormonal responses after surgery are characterized by increased pituitary-adrenal axis hormones. We undertook this study to determine whether the choice of anesthesia influences stress hormone levels. Twenty-three adult females scheduled for hysterectomy for benign disease under general anesthesia were randomly assigned to one of three groups: epidural/propofol anesthesia (Group P), epidural/midazolam anesthesia (Group M), and epidural/sevoflurane anesthesia (Group S). The concentrations of ACTH and cortisol in group P and group M were significantly less than that of group S at 60 min after the incision. The concentrations of beta-endorphin and aldosterone in group P and group M were significantly less than that of group S at 60 min after the incision and after extubation. We conclude that combined epidural and general anesthesia with propofol or midazolam has a greater suppressive effect than sevoflurane on the stress response of the pituitary-adrenal axis during hysterectomy.