Correlations of preoperative hormonal changes with propofol and remifentanil requirements in pituitary adenoma patients

Kim, Eun Mi; Choi, Eun Mi; Choi, Seung Ho; Heo, Sang Baek; Min, Kyeong Tae

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Clinical Research

Neuroanesthesia

Anesthesia and Pain Medicine 2010;5(2):146-150.
Published online April 30, 2010.

Correlations of preoperative hormonal changes with propofol and remifentanil requirements in pituitary adenoma patients

Eun Mi Kim, Eun Mi Choi, Seung Ho Choi, Sang Baek Heo, Kyeong Tae Min

¹Department of Anesthesiology and Pain Medicine, Yonsei University Health System, Seoul, Korea.
²Research Instititute of Anesthesia and Pain, Seoul, Korea. ktmin501@yuhs.ac

Abstract

BACKGROUND
Anesthetic requirements are affected by the preoperative levels of some hormones. This study investigated to identify the hormonal status such as plasma level and maximal secretary capacity correlating with propofol and remifentanil requirements in pituitary adenoma patients who show various hormonal secretory states perioperatively.
METHODS
From 51 adult female pituitary adenoma patients, preoperative basal values and maximal stimulated levels of various hormones related to the axis of hypothalamus-pituitary-target organs on combined pituitary function test were recorded. Total intravenous anesthesia using target controlled infusion with propofol and remifentanil was administered. The effect-site concentration (Ce) of propofol reaching anesthetic induction and the consumed dosages of propofol and remifentanil during operation were measured. Anesthetic maintenance was controlled within 30% of preanesthetic hemodynamic variables by remifentanil and within ranges of BIS 45 +/- 10 by propofol. Spearman correlations between hormonal status and anesthetic requirements such as propofol Ce for induction, total consumed doses of propofol and remifentanil were performed with a statistical significance at P of 0.05.
RESULTS
The preoperative basal level of ACTH was correlated positively with propofol induction Ce and maintenance dose, and the maximal secretory capacity of prolactin also correlated positively with propofol induction Ce. Remifentanil consumption dose was not related with any hormones measured regardless of either preoperative basal levels or maximal secretory levels.
CONCLUSIONS
Propofol requirements may be related with preoperative plasma level of ACTH or maximal secretory capacity of prolactin.

Key Words: Effect-site concentration, Hormones, Pituitary adenoma, Propofol, Remifentanil

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