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GENERAL ARTICLES

Propofol/Sufentanil Anesthesia Suppresses the Metabolic and Endocrine Response During, Not After, Lower Abdominal Surgery

Thomas Schricker, MD, PhD^*, Franco Carli, MD, MPhil^*, Markus Schreiber, MD, Ulrich Wachter, Wolfgang Geisser, MD, Ralph Lattermann, MD, and Michael Georgieff, MD, PhD

*Department of Anesthesia, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada; and Clinic of Anesthesiology, Ulm University, Ulm, Germany

Address for correspondence and reprints to Dr. Thomas Schricker, Department of Anesthesia, McGill University, Royal Victoria Hospital, 687 Pine Ave. West, Montreal, Quebec, Canada H3A 1A1. Address e-mail to mbek@mcgill.musica.ca.

We investigated the influence of propofol/sufentanil anesthesia on metabolic and endocrine responses during, and immediately after, lower abdominal surgery. Twenty otherwise healthy patients undergoing abdominal hysterectomy for benign myoma received either continuous infusions of propofol supplemented with sufentanil (0.01 µg · kg^-1 · min^-1, n = 10) or enflurane anesthesia (enflurane, n = 10). Plasma concentrations of glucose, lactate, free fatty acids, triglycerides, insulin, glucagon, cortisol, epinephrine, and norepinephrine were measured before, during, and 2 h after surgery. Pre- and postoperative endogenous glucose production (R_a glucose) was analyzed by an isotope dilution technique by using [6,6-²H₂] glucose. Propofol/sufentanil anesthesia prevented the increase in plasma cortisol and catecholamine concentrations and attenuated the hyperglycemic response during surgery without showing any difference after the operation. Mediated through a higher glucagon/insulin quotient (propofol/sufentanil 15 ± 7 versus enflurane 8 ± 4 pg/µU, P < 0.05), the R_a glucose postoperatively increased more in the propofol/sufentanil than in the enflurane group (propofol/sufentanil 15.6 ± 2.0 versus enflurane 13.4 ± 2.2 µmol · kg^-1 · min^-1, P < 0.05).

Implications: The concept of stress-free anesthesia using propofol combined with sufentanil is valid only during surgery. The metabolic endocrine stress response 2 h after the operation is more pronounced than after inhaled anesthesia.

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