Surgical stress hormone response is reduced after awake videothoracoscopy

Objectives: To evaluate comparatively stress-hormone response after videothoracoscopic procedures performed with either epidural anaesthesia alone in awake patients, or with general anaesthesia and one-lung ventilation. Methods: Twenty-one patients with non-malignant pleuropulmonary disease were randomly divided into two groups, an awake group (11 patients) and a general anaesthesia group (10 patients). In all patients, ACTH, cortisol, epinephrine-norepinephrine, and glucose levels were assessed at baseline, 3 h postoperatively (T1), and on postoperative mornings 1 (T2) and 3 (T3). Aspecific acute-response factors (fibrinogen, C-reactive protein and whitecells), blood-pressure, and heart rate were also recorded at the same time intervals. Results: Surgical procedures entailed wedge resection of lung nodules (n=14, 66.7%), lung/pleural biopsies (n=5, 23.8%), and blebectomy-pleuroabrasion (n=2, 9.5%). No complication occurred. At T1, epinephrine increased significantly (median-Δ: 4 ng/l, QR: 4–6 ng/l, P=0.02) in the whole cohort, with no inter-group difference. Cortisol level was lower in the awake group (155 μg/l, QR: 130–164 μg/l vs. 230 μg/l, QR: 210–240 μg/l, P=0.001). Absolute cortisol increase was significant in the control group only (median-Δ: 50 μl/l, QR: 37–104, P=0.017). At T2, cortisol remained lower in the awake group (152 μg/l, QR: 127–162 μg/l vs. 192 μg/l, QR: 180–258 μg/l, P=0.002), while at T3, there was no inter-group difference. In both groups, cortisol levels proved unrelated to changes in ACTH (R=0.23, P=0.46). Glucose was higher in the control group (137 mg/dl, QR: 120–142 mg/dl vs. 98 mg/dl, QR: 92–110 mg/dl, P=0.01) at T2. No inter-group difference was found in aspecific acute-response factors levels. Conclusions: Our study suggests that awake videothoracoscopy results in lower surgical stress hormonal response than procedures performed with general anaesthesia.