الفهرس 
acknowledgmentOnly 14 pages are availabe for public view
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Abstract
he neuroendocrine response to stress appears to assist survival by providing appropriate substrates to maintain the function of vital organs. However, in modern anaesthetic and surgical practice v/here severe physiological disturbances are prevented or rapidly treated, any benifits of this response are no longer apparent. Furthermore, many of the intra-and/or post-operative morbidities are assumed to be stress related. Therefore, extensive studies have been carried out to alleviate or at least attenuate the stress response during surgical practice.
The aim of this work was to compare the effects of two anaesthetic techniques on the stress response to surgery.
This study included twenty fit adult patients 13 males and 7 females. Their age ranged from 29 to 58 , and their weight ranged from 64 to 90 K<j.
These patients had underwent laminectomy for removal of prolapsed disc. Premedication was done in the form of diazepam lOmg intramuscularly 30 minutes before the induction of anaesthesia. And atropine sulphate lmg intravenously with the induction of anaesthesia.
Induction of anaesthesia was done with thiopentone
sodium 4-6 mg kg intravenously. Neuromuscular blockade
•* -1
produced with pancuronium bromide 0.1 mg kg intravenously.
Ventilation was controlled mechanically via suitable cuffed
endotracheal tube., Maintenance of anaesthesia was done
with a mixture of 60% nitrous oxide in oxygen. According to
the anaesthetic supplementation the patients were classified
into two groups. Group I, fentanyl was used as a supplement
in an initial dose of 10 ug kg with further doses of
2.5 ug kg as required. Group II,halothane 0.5-1.5 percent
was used as a supplement to anaesthesia. No intravenous
glucose infusion was given to any of the studied patients,
only lactated Ringer’s solution, was administered i.v. during
surgery. To study the effect of anaesthesia per se, 15 minutes
were elapsed from endotracheal intubation till skin incision.
For every patient included in this study venous blood samples
were taken at 4 occasions: before induction (control),
15 minutes after induction, 30 minutes after skin incision,
and 15 minutes after recovery.
For every venous sample the following parameters were measured:
1- Plasma Cortisol level using ENDAB Cortisol enzyme immunoassay kit.
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2 . Blood glucose level using glucose oxidase method. 3. Serum insulin level using coat-A-count kit for insulin radioimmunoassay.
The results of this study showed:
In the fentanyl group of patients the pre-induction level
of plasma Cortisol was ( 26 . 6±8 . 72 ^ug% ) and increased
insignificantly during anaesthesia to (27.2±9.33^ug%), during
surgery there was a significant increase (30.9±9.36ug%), and
a more apparent increase was found after recovery ( 3 5 . 3 ± 10 .4 2
ug%). In the halothane group of patients the pre-induction
level of plasma Cortisol was (23.9±6.6l_^ug%) which increased
significantly during anaesthesia to (34.2±7.89_^ug%), a more
significant increase during surgery ( 3 9 . 9 ± 6 . 81u g % ) g n d a further
increase after recovery (46.6±6.637 Jlg%). The results obtained
for plasma Cortisol level were significantly higher in the
halothane group than in fentanyl group during anaesthesia, surgery and recovery .
The results obtained for blood glucose level were nearly concomitant with plasma Cortisol level in both groups; Thus in the fentanyl group there was an insignificant decrease during anaesthesia (from 91.7±13.18 to 8 9.3±10.44 mg %) , during surgery there was a significant increase (100.5±14.82 mg%), and a further increase after recovery (108.0±14.05 m g %) .
Also, the results of halothane group as regard the blood glucose level were significantly higher than the fentanyl group, thus , during anaesthesia there was a significant increase (from 88.5±8.985 to 101.3±11.44 mg%), a more significant increase during surgery (122.1±15.37 mg%), and a further increase after recovery (134.2±14.54 mg%).
On the other hand, tiie results obtained for serum insulin level showed a significant decrease in both groups. In the fentanyl group there was a significant decrease in serum insulin level during anaesthesia (from 12.2±3.56 to L0.57±2.66JUIU ml ), a more decrease during surgery (9.51± 2.65 juIU ml ), and still, significant decrease after recovery (8.77±2.96 uIU ml-1).
In the halothane group, as well, there was a significant
-1
decrease during anaesthesia (from 11 . 9 ± 5 .17 to 10.214.73^11] ml ),
mo
re decrease during surgery ( 9 . 0 ± 5 . 1 7 5 JU IU ml ), and more
1
significant decrease after recovery (7.98+4.18 uIU ml ). There was no significant differences in the serum insulin levels between the fentanyl and halothane groups during anaesthesia, surgery^and recovery.