| ObjectiveIn recent years, the morbitidy of carcinoma of stomach has gradually increased, and most patients need to receive the treatment of surgical operation. The anesthesia and operation usually result in fierce stress reaction which can interfere with immunity system of operative patients and lower the survival rate of perioperative patients. The trauma of anesthesia and surgery are the significant factors in observed perioperative stress reaction. General anesthetics such as propofol, etomidate, and isoflurane will effect on stress reaction to some degree during anesthesia due to their different pharmacal actions. There are a few studies of general anesthetics which effected on stress reaction for the radical operations for carcinoma of stomach now. The aim of this experiment is to investigate the changes of the serum interleukin-6, cortisol, insulin and blood sugar of the patients for radical operations for carcinoma of stomach in the perioperitive process, to investigate the exactly mechanism of propofol, etomidate and isoflurane to stress reaction and to select the most effective general anesthetic for clinical anesthesia which could inhibit the perioperative stress reaction for radical operations of carcinoma of stomach.Materials and MethodsThis experiment included 30 patients (male 21 and female 9, aged 58.73+6.72yr, weight 60.93+4.99kg, ASA I ~ II), scheduled to undergo radical operations forcarcinoma of stomach. They were randomly divided into three groups, Group P (propofol group, n=10), Group E (etomidate group, n=10) and Group I (isoflurane group, n=10). The same anesthetic technique was used in the three groups. Gerneral anesthesia was induced with midazolam 0.1-0.15mg kg-1, vecuronium 0.1mg kg-1 and fentanyl 4-5ug kg-1 IV in the three groups. Anesthesia was maintained with injection of fentanyl and vecuronium respectively. In Group P patients were infused with propofol 4~6mg kg-1 h-1, in Group E infused with etomidate 12~15ug kg-1 min-1 by using a syringe-type infusion pump and in Group I patients were inhaled with isoflurane 1.5~2vol% continuously. Blood samples were drawn from subclavicular vein at time of 5min before anesthesia (T1), 60min after anesthesia (T2), 5min postoperatively (T3), 24h postoperatively (T4) and 48h postoperatively (T5). The serum interleukin-6 and cortisol were measured from T1 to T5 time points by radioimmunoassay. The serum insulin was only measured from T1 to T3 time points by radioimmunoassay and the blood sugar was also measured from T1 to T3 time points by using the blood sugar measurement apparatus. There was another group (Group C, n=10) of healthy individuals without anesthesia and surgery in order to found the normal results of the serum interleukin-6, cortisol, insulin and blood sugar. Results(1) The comparison of the serum IL-6, cortisol, insulin and blood sugar levels at T1 time point among Group P, E, I and C: The content of serum cortisol in Group P, E and I were all higher than that in Group C at T1 time point, and the difference was significant (Group P: P=0.007; Group E: P=0.011; Group I: P=0.005 ). There was no significant difference of the serum cortisol levels among Group P, E and I (P>0.05) and there was no significant difference of the serum IL-6, insulin and blood sugar levels among the four groups either (P>0.05).(2) The changes of the serum IL-6 levels in Group P, E and I during the perioperative process.Comparison of the serum IL-6 levels at T2, T3, T4 and T5 time points with T1 time point: The content of the serum IL-6 had gradually increased after the anesthesia and the beginning of the operations in all three groups. (1)in Group P although it was higher at T2 and T3 time points than that at T1 time point, but there was no difference between the two time points (T2 time point: P=0.068; T3 time point: P=0.084). At T4 time point it was higher than that at T1 time point (P=0.000). There was no difference between T5and T1 time points (F=1.000). (2)In Group E it was significantly higher at T2, T3, T4 and T5 tim...
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