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Objective: To examine the effect of general anesthesia and epidural analgesia on hemodynamic parameters, acute phase reactant, serum albumin and homocysteine levels, in elective major abdominal surgery. Material and Methods: 60 ASA I-II cases scheduled for upper abdominal surgery were divided into two groups, general anesthesia (GA) and general anesthesia+epidural analgesia (GA+EA). In the GA+EA group a 10 ml bolus of 0.1% bupivacaine was administered through a T6-T7 or T7-T8 epidural catheter. Both groups received general anesthesia of i.v. 1 mg/kg lidocaine, 2 mg/kg propofol and 0.6 mg/kg rocuronium. Maintenance anesthesia was established with 1.5% sevoflurane in 50% N2O and 50% O2. N2O was not given in the group receiving GA+EA. Plasma Stress Hormone Levels were investigated preoperatively, at the end of surgery and 8 and 24 h postoperatively. Results: Demographic data and C-reaktif protein (CRP), Erythrocyte Sedimentation Rate (ESR), prealbumin, neutrophil and cortisol counts did not differ significantly between the groups. Glucose at the end of surgery (p=0.030) and albumin at the 24th h postoperatively (p=0.031) were higher in the GA+EA group. In the GA group, homocysteine levels at the end of surgery were higher than those in the GA+EA group (P=0.049). Conclusion: We conclude that EA establishes better hemodynamics in major abdominal surgery, but has a limited effect on hormonal, metabolic and inflammatory response. We think that epidural anesthesia and analgesia may represent alternative techniques in patients with homocystinuria or hyperhomocysteinemia and that a nitrogen protoxide-related increase occurs in homocysteine levels.

the world clinics journal of medical sciences

The Effect of General Anesthesia and Thoracic Epidural Analgesia on Stress Response and Homocysteine Levels in Major Upper Abdominal Surgery: A Prospective Randomised Study