Abstract
Anesthesia and surgical stress may produce distinct neuronal and metabolic responses, but comparative data on perioperative biomarker trajectories after general and spinal anesthesia remain limited. This prospective observational study aimed to compare circulating neuron-specific enolase (NSE), adiponectin, and visinin-like protein-1 (VSNL1) in adults undergoing elective surgery under general anesthesia (GA) or spinal anesthesia (SA). Ninety-seven patients (GA, n = 52; SA, n = 45) underwent serum sampling preoperatively and at 6 and 24 hours postoperatively, and biomarker concentrations were measured using enzyme-linked immunosorbent assay (ELISA). Longitudinal associations were assessed using linear mixed-effects models adjusted for age, body mass index (BMI), operation duration, and surgical procedure type, with additional baseline-adjusted analyses for adiponectin. NSE increased in both groups but rose less in the SA group than in the GA group at 6 hours (adjusted interaction estimate, −7.765 ng/mL; p < 0.001) and 24 hours (−4.005 ng/mL; p < 0.001). Adiponectin decreased postoperatively, but group-by-time interactions were not significant, and baseline-adjusted analyses showed no significant association between anesthesia modality and adiponectin at either postoperative time point. VSNL1 increased over time; the group-by-time interaction was not significant at 6 hours but was significant at 24 hours (estimate, 0.635 ng/mL; p < 0.001), indicating a differential late trajectory. Perioperative biomarker trajectories differed between GA and SA, most consistently for NSE. However, nonrandom anesthesia assignment, substantial differences in surgical case mix and operation duration, and the absence of neurocognitive outcome assessment preclude causal or clinical interpretation. These findings should be regarded as exploratory adjusted associations and validated in larger, more homogeneous surgical cohorts.