Stress and fluid restriction before anesthesia induction, investigation of the effects of the patient’s clinic, endocrine responses, and the level of the Nesfatin-1

Abstract

Background/Aim: Preoperative fasting, fluid restriction and stress trigger many hormonal responses, one of which is the newly described Nefsatin-1. It has important effects on energy metabolism and stress. In this study, we aimed to examine the relationship between stress, fasting, fluid restriction, and Nesfatin-1. Methods: A total of 100 ASA I-II adult patients between 18 and 60 years of age with no psychiatric, cardiovascular, or metabolic disorders, who were operated under general anesthesia for various reasons at Firat University Hospital between June and November 2013 were included in this randomized prospective case-control study. Patients were categorized into fluid restriction (Group 1) and no-fluid restriction (Group 2) groups. These groups were further sub-categorized as those receiving (Groups 1A and 2A) and not receiving pre-medication (Group 1B and Group 2B). State Trait Anxiety Inventory was applied to all patients by an independent member of the research team before the surgical procedure. Also, blood samples were obtained 6-8 hours, 1 hour, and just before the induction to measure insulin, glucose, epinephrine, norepinephrine, cortisol, and Nesfatin-1 levels. Results: In both groups, the test score for pre-operative anxiety was 44. While there were no differences in serum insulin levels between the study groups (P>0.05), serum glucose and epinephrine levels were higher in Group 1A than in other groups (P<0.05 for both). Except for the 2nd period, serum norepinephrine levels were elevated in all stages (P<0.05). Serum cortisol levels were higher in Group 2B (P<0.05), while serum Nesfatin-1 levels were higher in Group 2A (P<0.05). Conclusion: According to our findings, the highest reflection of stress in patients, together with clinical and endocrine responses, coincided just before the induction period. Further studies are warranted before firmer conclusions can be drawn regarding the association between Nesfatin-1 and anxiety. We believe that if the pathophysiological mechanisms between anxiety and Nesfatin-1 are clarified, Nesfatin-1 targeting treatment approaches can be tried in the clinic.