Dynamics of Biochemical Markers of Operational Stress in the Blood of Patients with Surgical Interventions on the Lumbar Spine Depending on the Type of Anesthesia

The article deals with questions of influence of anesthesia on glucose, cortisol and insulin parameters in patients during surgical interventions on the lumbar spine of the spine to assess the degree of stress response. Material and methods. The study included 23 patients aged 18-65, ASA I-II with degenerative-dystrophic spinal diseases, undergoing planned surgical interventions with transpedicular stabilization of 1-2 segments. None of the patients had a history of diabetes mellitus. Results and discussion. All of the patients under study were scheduled to be in the first operational phase (at 8 o'clock in the morning). Patients in the CA group (n=11, female – 6, male – 5) performed spinal anesthesia with a hyperbaric 0.5 % solution of bupivacaine (4 ml) in sedentary position. Subsequently, the patients were in the back position for 5 minutes followed by turning to the abdomen. Patients in the GA group (n=12, women – 5, men – 7) performed general intravenous anesthesia with artificial ventilation of lungs (propofol, fentanyl, atracurium in common doses). In the CA group, the average age was 51.0±12.0 years, the body mass index BMI=27.0±2.90 kg / m2, duration of operation – 110.0 ± 17.0 minutes; in the group of patients the average age was 45.0±16.0 years, BMI= 28.0±5.50, duration of operation – 114.0±20.0 minutes. The control group consisted of 11 practically healthy people. Blood collection was carried out at the following time intervals: T1 – before the start of anesthesia, T2 – 30 minutes after the incision, T3 – 3 hours after the incision, T4 – 24 hours after surgery. Blood glucose, cortisol and insulin were determined in the serum. The level of glycaemia in 30 minutes after the beginning of the operation in the group GA was no different from the SA group. After 3 hours, the blood glucose content of the patients in the GA group was increased by 6.8 %, after 24 hours – by 5.2 % compared with patients in the SA group. The level of cortisol in the blood 30 minutes after the incision was elevated in both groups as compared to the control, however, in the groups of GA and SA did not differ. After 3 hours after the incision, the cortisol content was elevated in the GA group by 22.0 % compared with the SA group, but after 24 hours, its level did not differ in the experimental and control groups. Conclusions. The decrease in insulin content in the blood was established only 30 minutes after the incision in the GA group by 29.4 % compared with the SA group. Dynamics of glucose and cortisol content in the group of patients with SA compared with the group of GA indicates a lower degree of manifestation of stress-reaction of the organism to surgical intervention. The insulin content in the blood of patients in the group GA decreased 30 minutes after the incision and did not differ from that of the control group 3 and 24 hours after the operation.