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AMBULATORY ANESTHESIA

Increased Progesterone Production During the Luteal Phase of Menstruation May Decrease Anesthetic Requirement

Veysel Erden, MD^*, Zehra Yangn, MD^*, Kerem Erkalp, MD^*, Hamdi Delatiolu, MD^*, Feyza Bahçeci, MD^*, and Aye Seyhan, MD

*Departments of Anesthesiology and Obstetrics/Gynecology, SSK Vakf Gureba Hospital, Istanbul, Turkey

Address correspondence and reprint requests to Zehra Yangn, MD, Siyavupaa cad. Lale sok. No: 8/20 Bahçelievler, Istanbul. Address e-mail to zehrayangin{at}hotmail.com or zehrayangin{at}yahoo.com.

Besides having important hormonal effects, progesterone has depressant and hypnotic effects on the brain. In this study, we compared women in the follicular phase with low progesterone levels and in the luteal phase with high progesterone levels regarding their anesthetic requirements. Twenty patients with menstrual cycle days from 1 to 10 (follicular group) and 20 patients with menstrual cycle days from 18 to 24 (luteal group) were included in the study. Anesthesia was induced with fentanyl and thiopental; relaxation was secured with rocuronium, and anesthesia was maintained with a mixture of nitrous oxide 2 L/min and oxygen 2 L/min plus sevoflurane. The delivered sevoflurane concentration was adjusted to sustain a constant bispectral index value that averaged 46 in both groups. To determine the progesterone levels, blood samples were taken from all patients before surgery. We found that progesterone levels were 0.86 ± 0.30 ng/mL in the follicular group and 7.48 ± 3.86 ng/mL in the luteal group. The minimum alveolar anesthetic concentration (MAC)-hour (MAC-h) value of sevoflurane in the follicular group (1.55 ± 0.18 MAC-h) was significantly larger than in the luteal group (1.3 ± 0.13 MAC-h) (P < 0.0001). The sevoflurane requirements were larger in the follicular group during the maintenance phase of anesthesia. In conclusion, high progesterone levels during the luteal phase might be the cause of decreased anesthetic requirement.

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