Serum levels of cortisol and prolactin in patients treated under total intravenous anesthesia with propofol-fentanyl and under balanced anesthesia with isoflurane-fentanyl

Abstract: The study was designed to determine pre-, intra-and postoperative serum cortisol and prolactin (PRL) concentrations in patients subjected to low abdominal surgery under total intravenous anesthesia (TIVA) with propofol-fentanyl, and under general balanced anesthesia with isoflurane-fentanyl. The prospective study included 50 patients of both sexes, aged between 35 and 60 years, subjected to elective low abdominal surgery. Patients were randomly divided into two groups: an experimental group, consisting of 25 ASA I/II (American Society of Anesthesiologists I/II classification) patients treated under TIVA with propofol-fentanyl, and a control group consisting of 25 ASA I/II patients treated under balanced anesthesia with isoflurane-fentanyl. The length of the surgery and the degree of the surgical trauma did not differ significantly between the two anesthesia groups. Blood samples for cortisol and PRL measurements were drawn at exact time points: 30 minutes before the beginning of the surgery (T₀), 30 minutes after the beginning of the surgery (T₁), at the end of the surgery (T₂), 2 hours after the surgery (T₃), and 24 hours after the surgery (T₄). Serum levels of cortisol and PRL were measured using commercially available kits. The results were evaluated with the nonparametric Mann-Whitney test. The serum concentration of cortisol measured at T₁ time point in patients treated under TIVA was significantly lower (p=0.04) than that in patients treated under general balanced anesthesia. The average circulating levels of PRL measured at T₁, T₂ and T₃ time points in patients treated under TIVA were significantly lower (p=0.003; p=0.002; p<0.05; respectively) than those in patients treated under balanced anesthesia. The results obtained suggest that the endocrine stress response developed in response to surgery is probably attenuated in patients treated under TIVA with propofol-fentanyl and, thus, that these patients are less stressed in comparison to patients treated under general balanced anesthesia with isoflurane-fentanyl.