Desflurane versus sevoflurane: a comparison on stress response

Area of Science:

• Anesthesiology
• Surgical Stress Response
• Endocrinology

Background:

• Surgical procedures induce neurohumoral, immunologic, and metabolic alterations.
• Anesthetic technique influences the intensity of surgical stress response.

Purpose of the Study:

• To compare the effects of desflurane versus sevoflurane anesthesia on intraoperative and postoperative stress hormone and inflammatory cytokine release.
• To evaluate the stress response to desflurane and sevoflurane in patients undergoing laparoscopic surgery.

Main Methods:

• Fifty women undergoing laparoscopic surgery were randomized to desflurane (DES) or sevoflurane (SEVO) anesthesia.
• Plasma levels of catecholamines (adrenaline, noradrenaline), ACTH, cortisol, IL-6, glucose, and CRP were measured at multiple time points.
• Fentanyl and remifentanil were administered for analgesia.

Main Results:

• Both anesthetics increased catecholamines, but desflurane showed significantly higher adrenaline and noradrenaline levels.
• Desflurane anesthesia was associated with a significant intraoperative drop in cortisol compared to baseline and sevoflurane.
• ACTH levels increased significantly more with sevoflurane intraoperatively, while desflurane attenuated postoperative ACTH secretion.
• No significant differences were observed in IL-6, glucose, CRP levels, or postoperative pain between the groups.

Conclusions:

• Desflurane and sevoflurane induce distinct stress responses during laparoscopic surgery.
• The heightened catecholamine release with desflurane may pose risks for patients with cardiovascular disease.
• Desflurane demonstrated superior control over intraoperative cortisol and ACTH responses compared to sevoflurane.
• Neither anesthetic agent impacted IL-6, CRP, or glucose levels.