Effects of etomidate on blood cortisol, insulin, and glucose levels and PONV rates in smokers

To observe differences in the effects of etomidate, used for anesthesia induction, on surgery-induced endocrine response and postoperative nausea and vomiting (PONV) among nonsmokers and smokers. Materials and methods: Eighty adult patients with ASA I-II risk status were randomly divided into 2 groups: smokers (Group I, n = 40) and nonsmokers (Group II, n = 40). Patients were then further divided into subgroups according to the drug used for anesthesia induction, either propofol (Group IP and Group IIP) or etomidate (Group IE and Group IIE). Blood cortisol, insulin, glucose, and white blood cell (WBC) levels were measured and PONV scores were recorded. Results: Blood cortisol values were significantly lower in Group IE and Group IIE compared to Group IP and Group IIP during the 1st and 2nd hours after induction. By the 8th hour, blood insulin levels had increased significantly compared to the baseline values in Groups IE, IP, and IIP. Blood glucose levels were significantly higher in Group IIE compared to both Group IP and Group IIP. There was no significant difference between the WBC levels of the different groups. PONV scores were significantly higher in Group IIE compared to the other groups. Conclusion: We determined that the use of etomidate causes a lower stress response and more PONV compared to propofol, while smoking increases the stress response and decreases PONV.

Eff ects of etomidate on blood cortisol, insulin, and glucose levels and PONV rates in smokers

To observe differences in the effects of etomidate, used for anesthesia induction, on surgery-induced endocrine response and postoperative nausea and vomiting (PONV) among nonsmokers and smokers. Materials and methods: Eighty adult patients with ASA I-II risk status were randomly divided into 2 groups: smokers (Group I, n = 40) and nonsmokers (Group II, n = 40). Patients were then further divided into subgroups according to the drug used for anesthesia induction, either propofol (Group IP and Group IIP) or etomidate (Group IE and Group IIE). Blood cortisol, insulin, glucose, and white blood cell (WBC) levels were measured and PONV scores were recorded. Results: Blood cortisol values were significantly lower in Group IE and Group IIE compared to Group IP and Group IIP during the 1st and 2nd hours after induction. By the 8th hour, blood insulin levels had increased significantly compared to the baseline values in Groups IE, IP, and IIP. Blood glucose levels were significantly higher in Group IIE compared to both Group IP and Group IIP. There was no significant difference between the WBC levels of the different groups. PONV scores were significantly higher in Group IIE compared to the other groups. Conclusion: We determined that the use of etomidate causes a lower stress response and more PONV compared to propofol, while smoking increases the stress response and decreases PONV.

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  • Rodrigo C. Th e eff ects of cigarette smoking on anesthesia. Anesth Prog 2000; 47: 143-150.
  • Wagner RL, White RF, Kan PG, Rosenthal MH, Feldman D. Inhibition of adrenal steroidogenesis by the anesthetic etomidate. N Engl J Med 1984; 310: 1415-21. 9. Figueroa M. Th e postanesthesia recovery score: a second look. Southern Medical Journal 1972; 65: 791-5.
  • Dönmez A, Kaya H, Haberal A, Kutsal A, Arslan G. Th e eff ect of etomidate induction on plasma cortisol levels in children undergoing cardiac surgery. J Cardiothorac Vasc Anesth 1998; 12: 182-5.
  • Crozier TA, Schlaeger M, Wuttke W, Kettler D. TIVA with etomidate-fentanyl versus midazolam-fentanyl. Th e perioperative stress of coronary surgery overcomes the inhibition of cortisol synthesis caused by etomidate-fentanyl anesthesia. Anaesthesist 1994; 43: 605-13.
  • Fragen RJ, Weiss HW, Molteni A. Th e eff ect of propofol on adrenocortical steroidogenesis: a comparative study with etomidate and thiopental. Anesthesiology 1987; 66: 839-42.
  • Lambert A, Mitchell R, Robertson WR. Eff ect of propofol, thiopentone and etomidate on adrenal steroidogenesis in vitro. Br J Anaesth 1985; 57: 505-8.
  • Ng AS, Tan SS, Lee HS, Chew SL. Eff ect of propofol infusion on the endocrine response to cardiac surgery. Anaesth Intensive Care 1995; 23: 543-7.
  • Fuxe K, Andersson K, Eneroth P, Harfstrand A, Agnati LF. Neuroendocrine actions of nicotine and of exposure to cigarette smoke: medical implications. Psychoneuroendocrinology 1989; 14: 19-41.
  • Kawakami N, Takatsuka N, Shimizu H, Ishibashi H. Eff ects of smoking on incidence of non-insulin dependent diabetes mellitus. Am J Epidemiol. 1997; 15:103-9.
  • Eliasson B, Mero N, Taskinen MR, Smith U. Th e insulin resistance syndrome and postprandial lipid intolerance in smokers. Atherosclerosis 1997; 129: 79-88.
  • Daniel M, Cargo MD. Association between smoking, insulin resistance and beta-cell function in a North-western First Nation. Diabetic Medicine 2004; 21, 188-193.
  • Wareham NJ, Ness EM, Byrne CD, Cox BD, Day NE, Hales CN. Cigarette smoking is not associated with hyperinsulinemia: Evidence against a causal relationship between smoking and insulin resistance. Metabolism 1996; 45: 1551-6.
  • Pirbudak L, Balat O, Çekmen M, Ugur MG, Aygün S, Öner U. Eff ect of ascorbic acid on surgical stress response in gynecologic surgery. Int J Clin Pract 2004; 58: 928-31.
  • Myles PS, Buckland MR, Morgan DJ, Weeks AM. Serum lipid and glucose concentrations with a propofol infusion for cardiac surgery. J Cardiothorac Vasc Anesth 1995; 9: 373-8.
  • Schricker T, Carli F, Schreiber M, Wachter U, Geisser W, Lattermann R et al. Propofol/sufentanil anesthesia suppresses the metabolic and endocrine response during, not aft er, lower abdominal surgery. Anesth Analg 2000; 90: 450-5.
  • Moore RA, Allen MC, Wood PJ, Rees LH, Sear JW. Peri- operative endocrine eff ects of etomidate. Anaesthesia 1985; 40: 124-30.
  • Kulacoglu H, Ozdogan M, Gurer A, Ersoy EP, Onder Devay A, Duygulu Devay S et al. Prospective comparison of local, spinal, and general types of anaesthesia regarding oxidative stress following Lichtenstein hernia repair. Bratisl Lek Listy 2007; 108: 335-9.
  • Buyukkocak U, Caglayan O, Oral H, Basar H, Daphan C. Th e eff ects of anesthetic techniques on acute phase response at delivery (anesthesia and acute phase response). Clinical Biochemistry 2003; 36: 67-70.
  • Yokoyama M, Itano Y, Katayama H, Morimatsu H, Takeda Y, Takahashi T et al. Th e eff ects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy. Anesth Analg 2005; 101: 1521-7.
  • Aghamir SM, Mojtahedzadeh M, Meysamie A, Atharikia D, Izadpanah F, Sheikhvatan M. Comparison of systemic stress responses between percutaneous nephrolithotomy (PCNL) and open nephrolithotomy. J Endourol 2008; 22: 2495-500.
  • Brohee D, Vanhaeverbeek M, Kennes B, Neve P. Leukocyte and lymphocyte subsets aft er a short pharmacological stress by intravenous epinephrine and hydrocortisone in healthy humans. Int J Neurosci 1990; 53: 53-62.
  • Chimbira W, Sweeney BP. Th e eff ect of smoking on postoperative nausea and vomiting. Anaesthesia 2000; 55: 540- 4.
  • Moens P, Levarlet M, Hendrickx P. Single i.v. bolus dose of ondansetron in the prevention of postoperative nausea and emesis. Acta Anaesthesiol Belg 1997; 48: 245-50.
  • Smith I, White PF, Nathanson M, Gouldson R. Propofol, an update on its clinical use. Anesthesiology 1994; 81: 1005-43.
  • Sneyd JR, Carr A, Byrom WD. Bilski AJT. A meta-analysis of nausea and vomiting following maintenance of anesthesia with propofol or inhalation agents. Eur J Anaesthesiol 1998; 15: 433- 45.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Transient bradycardia in patients with Crimean-Congo hemorrhagic fever

Kemalettin ÖZDEN, Zülal ÖZKURT, Mustafa Kemal EROL, Serpil EROL, Mehmet PARLAK

Effects of etomidate on blood cortisol, insulin, and glucose levels and PONV rates in smokers

Ayşe Belin ÖZER, Fuat YILDIZ, Ömer Lütfi ERHAN, Cevdet SÜMER

BTLA (C272) expression on CD4+ T cells in Behçet patients

Nafiye Fulya İLHAN, Nesrin DEMİR, Tamer DEMİR, Ahmet GÖDEKMERDAN

Final baricity of ropivacaine or bupivacaine combined with fentanyl for intrathecal administration

Seval İZDEŞ, İrfan GÜNGÖR, Berrin GÜNAYDIN

Characteristics of patients transferred by air: a descriptive epidemiologic study

Erol ARMAĞAN, Ataman KÖSE, Ayça AKPINAR AÇIKALIN, Şule AYDIN, Beril KÖSE, Özlem KÖKSAL

Evaluation of the antibacterial activity of Zataria multiflora Boiss., Rhus coriaria L. (sumac), Mentha piperita L., and Ocimum basilicum L. extracts on Brucella strains isolated from brucellosis patients

Yousef MOTAHARINIA, Mohammad Ali REZAEE, Mohammad Saleh HAZHIR, Reza SHAPOUR, Mohammad Saied HAKHAMANESHI, Ahmad RASHIDI, Mohammad Reza RAHMANI, Farid ZANDI

Evaluation of vitamin B-12 level in middle-aged obese women with metabolic and non-metabolic syndrome: case-control study

Davut BALTACI, Ali KUTLUCAN, Serkan ÖZTÜRK, İsmail KARABULUT, Hayriye AK YILDIRIM, Ahmet ÇELER, Gökhan CELBEK, İsmail Hamdi KARA

Is the six-minute walk test correlated with disease control and quality of life in children with asthma?

Özge YILMAZ, Hasan YÜKSEL, Ayhan SÖĞÜT, Bülent GÖKŞEN, Senem ÜSTÜN

Prediction of mortality in stroke patients using multilayer perceptron neural networks

Necdet SÜT, Yahya ÇELİK

Sciatic nerve injury due to intramuscular injection: electrophysiological findings and one-year follow-up

Mehmet ADAM, Selda BAĞIŞ, Ümmühan Berrin LEBLEBİCİ, Adile Zeynep GÜVEN, Ayşe Reyhan ÇELİKER, Metin KARATAŞ