Treatment of stress response during balanced anesthesia. Comparative effects of isoflurane, alfentanil, and trimethaphan.

Article Details

Citation

Copy to clipboard

Monk TG, Mueller M, White PF

Treatment of stress response during balanced anesthesia. Comparative effects of isoflurane, alfentanil, and trimethaphan.

Anesthesiology. 1992 Jan;76(1):39-45.

PubMed ID

1346082 [ View in PubMed

]

Abstract

Acute hypertensive responses during nitrous oxide-opioid-relaxant anesthesia are a common clinical problem. In adult men undergoing radical prostatectomy procedures and anesthetized with a standardized technique, we evaluated the effectiveness of alfentanil, isoflurane, and trimethaphan in treating acute hemodynamic and stress hormone responses to surgical stimulation. Stress hormone concentrations were measured 1 min before skin incision, after the onset of an acute hypertensive response, and after returning the mean arterial pressure to within 10% of the preincision values with one of the three treatment modalities. Pretreatment plasma alfentanil concentrations (151 +/- 47 to 156 +/- 47 ng.ml-1) and end-tidal nitrous oxide concentrations (66 +/- 2 to 68 +/- 2%) were similar in all three groups. Acute hypertensive events were associated with significantly increased concentrations of catecholamines and vasopressin (antidiuretic hormone [ADH]). Whereas intravenous alfentanil returned all hormone concentrations to preincision values, norepinephrine and glucose concentrations were significantly increased after adjunctive isoflurane administration. Although trimethaphan decreased the norepinephrine concentration, the epinephrine, beta-endorphin, cortisol, ADH, and glucose concentrations were significantly increased compared to preincision values. However, the persistent elevation in the posttreatment ADH concentration in the trimethaphan group was the only significant difference between the three groups. Mean (+/- standard deviation) times to awakening (2.8 +/- 3.3 to 3.8 +/- 4.2 min), extubation (8.1 +/- 4.8 to 10.3 +/- 8.5 min), and orientation (19.6 +/- 20.4 to 24.6 +/- 19.1 min) were similar in all three groups. Naloxone was required more frequently in patients in the alfentanil (35%) and isoflurane (24%) groups than in the trimethaphan group (4%).(ABSTRACT TRUNCATED AT 250 WORDS)

DrugBank Data that Cites this Article

Pharmaco-metabolomics

Drug	Drug Groups	Metabolite	Change	Description
Trimethaphan	Approved Investigational	Norepinephrine	decreased	Trimethaphan decreases the level of Norepinephrine in the blood
Trimethaphan	Approved Investigational	Epinephrine	increased	Trimethaphan increases the level of Epinephrine in the blood
Trimethaphan	Approved Investigational	Beta-endorphin	increased	Trimethaphan increases the level of Beta-endorphin in the blood
Trimethaphan	Approved Investigational	Cortisol	increased	Trimethaphan increases the level of Cortisol in the blood
Trimethaphan	Approved Investigational	Antidiuretic hormone	increased	Trimethaphan increases the level of Antidiuretic hormone in the blood
Trimethaphan	Approved Investigational	Glucose	increased	Trimethaphan increases the level of Glucose in the blood