TIVA and VIMA on Blood Glucose and Insulin Levels in Lung Lobectomy Patients
Condition: Hyperglycemia Stress
MeSH terms: Hyperglycemia
Study type: Interventional

Summary: 
      The purpose of this study was to evaluate the efficacy and safety of sevoflurane-only
      Volatile induction and maintenance anesthesia (VIMA) and total intravenous anesthesia (TIVA)
      using only propofol in adult patients scheduled for elective lobectomy surgery. We would like
      to know if there is a difference in blood glucose levels during surgery and whether the cause
      is due to the difference in secretion of insulin and cortisol. In addition, we aim to
      contribute to the improvement of the prognosis of the patients by helping the selection of
      general anesthesia more effective in maintaining homeostasis in the surgical patients by
      general anesthesia and further controlling the blood glucose level.
    

Detailed description: 
      Before surgery, glycopyrrolate (0.2 mg) was administered intramuscularly. Immediately after
      arrival in the operating room, blood pressure, electrocardiogram and oxygen saturation are
      measured and monitored, and a bispectral index (BIS) is attached to the patient's forehead to
      determine the appropriate anesthetic depth during surgery. A 22G angiocatheter is inserted
      into the radial artery after local anesthesia with lidocaine to monitor the blood pressure in
      real time and to collect blood for arterial blood gas analysis during one side of pulmonary
      ventilation. General anesthesia induces loss of consciousness by using a randomly assigned
      systemic anesthetic (sevoflurane inhalation or propofol infusion). In the VIMA group, when 8%
      sevoflurane is inhaled with 100% oxygen at 6 L / min and the consciousness is lost, the
      concentration of sevoflurane is reduced to 2-3% and then the mask is ventilated. In the TIVA
      group, target controlled infusion (TCI) was performed with propofol 4 mcg / ml, and the
      patient was ventilated after disappearance of consciousness. When the consciousness of the
      subject is lost, remifentanil is administered as TCI with a target concentration of 1 ng / ml
      as an analgesic agent, and rocuronium 0.5 mg / kg is administered intravenously for
      intubation in both groups. If the patient's anesthesia depth is between BIS 40-60 and the
      respiratory muscles are fully relaxed, tracheal intubation is performed using the double
      lumen endobronchial tube (DLT). After confirming the DLT reaches the proper position with a
      flexible bronchoscope, mechanical ventilation is started by administering 50% oxygen. The
      central venous catheter is inserted into the operative subclavian vein and the central venous
      pressure is continuously monitored during the operation. During surgery, rocuronium is
      administered continuously so that the train-of-four (TOF) remains below two responses. In
      addition, warm blanket and warm air are supplied to the rest of the body except for the
      surgical site so that the patient can maintain normothermia during the operation. In all
      patients, surgery should start between 8:30 am and 9:00 am in order to prevent volatility of
      blood cortisol levels by activity cycle. During surgery, general anesthesia should be
      adjusted to maintain BIS 40-60, and remifentanil TCI should be maintained at 1 ng / ml for
      pain during surgery. The mean blood pressure during surgery is aimed at maintaining a 30%
      range on baseline so that hypotension or hypertension does not last more than 5 minutes.
      Hypotension and hypertension are controlled by intravenous injection of phenylephrine (50 μg
      / ml) and nicardipine (500 μg / ml), respectively. At the end of the operation and after the
      paravertebral block to control the postoperative pain, the administration of the general
      anesthetic and remifentanil is stopped and the spontaneous breathing is tried to be
      recovered. When patients begin spontaneous breathing, the effect of the remaining
      neuromuscular blockers is reversed using pyridostigmine (0.2 mg / kg) and glycopyrrolate
      (0.008 mg / kg). All patients are fully conscious and have a spontaneous respiration when
      they are exhaled and transferred to the postanesthetic care unit (PACU). PACU administers
      oxygen through a facial mask and monitors blood pressure, heart rate and oxygen saturation.
      Patients should be given 1 ug / kg of fentanyl when the visual analog scale (VAS) scores
      exceed 4 points
    

Intervention name(s): TIVA; VIMA
Intervention type(s): Drug; Drug
Intervention description(s): total intravenous anesthesia with propofol; volatile induction and maintenance anesthesia with sevoflurane
Other intervention name(s): propofol; sevoflurane
Intervention MeSH terms: Propofol; Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Anesthesia, intravenous; Anesthesia, inhalation; propofol; sevoflurane; glucose