The effect of combined epidural and light general anesthesia on stress hormones in open heart surgery patients

Byung Kook Chae, Hye Won Lee, Kyung Sun, Young Ho Choi, Hyoung Mook Kim

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40 Citations (Scopus)


This study was designed to evaluate the potential advantages of combined epidural and light general anesthesia over the commonly employed general anesthesia during open heart surgery. Twenty-four patients undergoing mitral valve replacement were thus studied. General anesthesia was maintained with an isoflurane-nitrous oxide-oxygen gas mixture and morphine sulfate (0.4mg/kg i.v. initially) followed by postoperative pain control with morphine in 12 patients (group GA). The remaining 12 patients (group EAA) received continuous epidural bupivacaine (0.125%)-morphine (50 μg/ml) supplemented with the same gas mixture as group GA. Epidural infusion was continued until the third postoperative day. Changes in the serum cortisol and β-endorphin levels together with postoperative pain relief defined as good (scale 0-2), fair (3-4), or poor (5-10) were observed serially. Lower cortisol levels were observed in group EAA than in group GA (P < 0.05) just before skin closure, on the second and the third postoperative day. The β-endorphin levels were substantially lower in group EAA than in group GA throughout the observation. The pain scores were good in 2 patients (17%), fair in 6 (50%), and poor in 4 (33%) for group GA, and good in 8 (67%), fair in 3 (25%), and poor in 1 (8%) for group EAA. We thus conclude that a combined epidural and light general anesthesia is considered to attenuate the stress response and thereby provides a better quality of postoperative pain control.

Original languageEnglish
Pages (from-to)727-731
Number of pages5
JournalSurgery Today
Issue number7
Publication statusPublished - 1998 Jan 1



  • Epidural anesthesia
  • Open heart surgery
  • Post-operative pain relief
  • Stress hormones

ASJC Scopus subject areas

  • Surgery

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