Curr Health Sci J, vol. 38, no. 4, 2012

Sedation impact over perioperative endocrine stress response in patients with increased anxiety undergoing total arthroplasty of the inferior limb

[Original paper]

MARIA STOICA(1), DANIELA CERNEA(1), ALICE DRAGOESCU(1), A. STOICA(2), F. PURCARU(1)


(1)Department of Anaesthesia and ICU, University of Medicine and Pharmacy of Craiova, Romania; 
(2)Department of Pediatric Surgery, University of Medicine and Pharmacy of Craiova, Romania


Abstract:

Purpose. Decreasing anxiety level through intraoperative sedation and postoperative anxiolysis can modulate perioperative neuroendocrine stress response. Material and Methods. This randomized prospective clinical study includes 48 patients subjected to total articular endoprothesis at hip and knee level, respectively. The patients included in the study were equally divided into 2 groups, each group comprising 24 patients: 12 patients with knee prothesis (TKA), and 12 patients with hip prothesis (THR). All patients benefited from subarachnoid anaesthesy.  In order to evaluate anxiety, there was used a STAI-X2 questionnaire for determining preoperatory anxiety and STAI-X1 questionnaire for determining preoperatory, post-operatory anxiety, immediately and the following day. The numerical scale was used to evaluate preoperatory pain (NRS), while the Wilson  scale was used for quantifying the intraoperatory sedation. Results. The situation anxiety in group As decreases significantly immediately after surgery, (p<0.0001 for TKA, THR respectively), the following day after surgery patients show slightly increased scores (p=0.0002 for TKA, p=0.0004 for THR) in comparison to the end of surgery. In the sedated patients (Group As), both for TKA and for THR, the level of cortisolemia significantly decreases immediately after surgery (p<0.0001 for TKA, THR, respectively). Seric glycemia is maintained relatively stable (even decreasing in the case of THR (p=0,00014) immediately after surgery in the patients in group As.Conclusions. Immediately after surgery, faced with surgery, there is a signficant correlation: situation anxiety-cortisolemia-glycemia. Intraoperatory sedation and postoperatory anxiolysis in patients with high anxiety may indirectly modulate the postoperatory neuroendocrine response.


Keywords:
anxiety, stress response, arthroplasty



Corresponding:
Maria Stoica, Department of Anaesthesia and ICU, Universitary No.1 Hospital Craiova, Tabaci Str, No.1, 200642, Dolj County, Romania. E-mail: mia.stoica69@gmail.com


DOI 10.12865/CHSJ.38.04.04 - Download PDF