الفهرس 
AnesthesiaOnly 14 pages are availabe for public view
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Abstract
Interest in mood disorders among women has
increased, and epidemiological studies suggest that the
incidence of major depressive disorder is higher among
women than men, even across different nation and cultures.
Women who present episodes of depression associated
with reproductive events (i.e., premenstrual, postpartum,
menopausal transition) may be particularly prone to
experiencing depression because of a heightened sensitivity
to intense hormonal fluctuations. The hypothesis that sex
hormone fluctuations that occur in female reproductive
events could influence neurochemical pathways linked to
depression is supported with existing animal and human
studies and with clinical data (Lee et al., 2015).
Female depression and female effective behaviors
are influenced by estradiol levels (Borrowand Cameron,
2014).There are multiple activities of estrogens on brain
neurotransmitters involving various genomic and nongenomic mechanisms.Estradiolmodulates dopaminergic
activity at various steps of dopamine transmission (i.e
dopamine release and metabolism, pre and postsynaptic
dopamine receptors and transporter (Cyr et al., 2002).
Estrogen receptors and serotonin receptors coexist in
cells in a wide variety of tissues. Many of 17-β estradiol
(E2) effectsare mediated by changes in the actions of
serotonin (5-HT). Serotonin is usually considered to be a
neurotransmitter, but surprisingly, only 1% of serotonin in
the human body is found in the central nervous system. the
remaining 99% is found in other tissues, primarily plasma,
the gastrointestinal tract and immune tissues where
serotonin acts as hormone regulating various physiological
functions including vasodilation, clotting, recruitment of
immune cells and gastrointestinal motility and iniation of
uterine contraction. Both naturally – occurring and
pharmacologically – induced changes in E2 alter the
concentration of serotonin through two mechanisms. First
E2 increases production of tryptophan hydroxylase (TPH,the rate limitating step in synthesis of serotonin in the
body) increasing the concentration of serotonin in the body.
Second E2 inhibits the expression of the gene for the
serotonin reuptake transporter (SERT) and acts as
antagonists at the SERT thus promoting the actions of
serotonin by increasing the time that it remains available in
synapsesand interstitial spaces (Rybaczyket al., 2005).
Isoflurane is an alternative anesthestic that produces
a stable level of anesthesia over extended periods and is
often used for recovery from surgeries.Despite these
benefits the effect of isoflurane on dopamine release and
uptake and the exact mechanisms of the impact of
isoflurane anesthesia on dopaminergic system is not fully
understood (Brodnik and Espona, 2015).In the present
study isoflurane anesthesia cause significant increase in
plasma dopamine level which lead to enhance mood and
pain relief.
Sex steroid hormones, estradiol and progesterone
play major roles in the development, differentiation,function and protection of central nervous system in
mammals. There is strong evidence that estrogen can
induce the development and protection of nigostriatal
dopaminergic neurons while the role of progesterone in the
dopamine system has not been completely determined. It
has been reported that progesterone dopaminergic neurons
against degradation, furthermore, progesterone
independently of estrogen can rapidly increase dopamine
release (Diaz etal, 2009).
The relationship between anesthetic or analgesics
agents and progesterone level in women has not been
studied (Lee and Ko, 2014). In this study we measure
progesterone and estrogen pre and postoperative and there
is a significant increase in progesterone postoperative and
decrease in estrogen blood levels. These prove that general
anesthesia enhances mood.