Propofol/sufentanil anesthesia suppresses the metabolic and endocrine response during, not after, lower abdominal surgery

We investigated the influence of propofol/sufentanil anesthesia on metaboli c and endocrine responses during, and immediately after, lower abdominal su rgery. Twenty otherwise healthy patients undergoing abdominal hysterectomy for benign myoma received either continuous infusions of propofol supplemen ted with sufentanil (0.01 mu g . kg(-1) . min(-1), n = 10) or enflurane ane sthesia (enflurane, n = 10). Plasma concentrations of glucose, lactate, fre e fatty acids, triglycerides, insulin, glucagon, cortisol, epinephrine, and norepinephrine were measured before, during, and 2 h after surgery. Pre- a nd postoperative endogenous glucose production (R-a glucose) was analyzed b y an isotope dilution technique by using [6,6-H-2(2)] glucose. Propofol/suf entanil anesthesia prevented the increase in plasma cortisol and catecholam ine concentrations and attenuated the hyperglycemic response during surgery without showing any difference after the operation. Mediated through a hig her glucagon/insulin quotient (propofol/sufentanil 15 +/- 7 versus enfluran e 8 +/- 4 pg/mu U, P < 0.05), the R-a glucose postoperatively increased mor e in the propofol/sufentanil than in the enflurane group (propofol/sufentan il 15.6 +/- 2.0 versus enflurane 13.4 +/- 2.2 mu mol . kg(-1) . min(-1), P < 0.05). Implications: The concept of stress-free anesthesia using propofol combined with sufentanil is valid only during surgery. The metabolic endoc rine stress response 2 h after the operation is more pronounced than after inhaled anesthesia.