Abstract
We studied the responses of plasma epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH) during and immediately after sevoflurane-nitrous oxide anaesthesia supplemented with vecuronium in seven elderly patients (mean 76.6 ± 1.7 SEM) who underwent major intra-abdominal surgery. The plasma concentrations of norepinephrine, ACTH, cortisol, and ADH increased in response to surgical procedures (P <0.05). The plasma concentration of ADH increased to a peak concentration of 189.1 ± 20.7 pg · ml−1 30 min after skin incision (P < 0.05). the plasma concentrations of epinephrine, norepinephrine, ACTH, and cortisol increased to peak concentrations of 408.6 ± 135.5 pg · ml−1, 635.7 ± 167.8 pg · ml−1, 222.6 ± 48.0 pg · ml−1, and 113.6 ± 67.5 μg · dI−1, respectively immediately after tracheal extubation (P <0.05). We conclude that, in the elderly patients, the responses of stress hormones to major intraabdominal surgery were preserved during sevoflurane-nitrous oxide anaesthesia sufficient to prevent increases in arterial pressure and heart rate. The strongest responses of epinephrine, norepinephrine, ACTH, and cortisol were elicited immediately after treacheal extubation.
Résumé
Cette étude porte sur les réponses de l’épinephrine, de la norépinéphrine, de ACTH, du cortisol, et de l’ADH pendant et immédiatement après l’anesthésie au sévoflurane-protoxyde d’azote supplémentée par du vécuronium chez sept patients avancés en âge (moyenne 76,6 ± 1,7 SEM) opérés pour une chirurgie viscérale majeure. Les concentrations plasmatiques de norépinephrine, d’ACTH, de cortisol, et d’ADH augmentent en réponse à la chirurgie (P < 0,05). La concentration plasmatique d’ADH atteint un maximum de 189,1 ± 20,7 pg · ml−1 après l’incision (P < 0,05). La concentration plasmatique de l’epinéphrine, de la norépinéphrine, de l’ACTH et du cortisol atteignent respectivement un maximum de 408,6 ± 135,5 pg · dl−1, 635,7 ± 167,8 pg · ml−1, 222,6 ± 48,0 pg · ml−1, et de 113,6 ± 67,5 μg · dl−1 immédiatement après l’intubation (P < 0,05). En conclusion, la réponse des hormones de stress à une chirurgie viscérale majeur chez le sujet âgé est conservées pendant une anesthésie au sévoflurane-protoxyde d’azote suffisamment profonde pour prévenir une montée de la pression artérielle et de la fréquence cardiaque. Les réponses les plus internes de l’épinéphrine, de la norépinéphrine, de l’ACTH et du cortisol sont survenues immédiatement après l’intubation de la trachée.
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References
West CD, Brown H, Simons EL, Carter DB, Kumagai LF, Englert E. Adrenocortical function and cortisol metabolism in old age. J Clin Endocrinol Metab 1961; 21: 1197–207.
Bowen DJ, Richardson DJ. Adrenocortical response to major surgery and anaesthesia in elderly patients. Br J Anaesth 1974; 46: 873–6.
Wallin RF, Regan BM, Napoli MD, Stern IJ. Sevoflurane: a new inhalational anesthetic agent. Anesth Analg 1975; 54: 758–66.
Eger EL Current status of sevoflurane and desflurane. 1992 Review course lectures, supplement to Anesthesia and Analgesia. 1992: 81–5.
Hjemdahl P, Daleskog M, Kahan T. Determination of plasma catecholamines by high performance liquid chromatography with electrochemical detection: comparison with a radioenzymatic method. Life Sci 1979; 25: 131–8.
Chrousos GP, Schulte HM, Oldfield EH, Gold PW, Cutler GB, Loriaux DL. The corticotropin-releasing factor stimulation test: an aid in the evaluation of patients with Cushing’s syndrome. N Engl J Med 1984; 310: 622–6.
Kao M, Voina S, Nichols A, Horton R. Parallel radioimmunoassay for plasma cortisol and l l-deoxycortisol. Clin Chem 1975; 21: 1644–7.
Thibonnier MJ, Marchetti JP, Corvol PL, Menard JE, Milliez P. Advantages and drawbacks of AVP radioimmunoassay in plasma and urine of normal subjects. Horm Metab Res 1981; 13: 300–1.
Murakawa T, Satoh X Kudo T, Kudo M, Matsuki A, Oyama T. Effects of sevoflurane anesthesia and surgery on plasma catecholamine levels. Jpn J Anesth 1989; 38: 1456–61.
Fleg JL, Tzankoff SP, Lakatta EG. Age-related augmentation of plasma catecholamines during dynamic exercise in healthy males. J Appl Physiol 1985; 59: 1033–9.
Murakawa T, Satoh Y, Kudo T, Kudo M, Matsuki A, Oyama T. Effects of sevoflurane anesthesia and surgery on anterior pituitary and adrenocortical function in man. Jpn J Anesth 1987; 36: 1058–63.
Udelsman R, Norton JA, Jelenich SE, et al. Responses of the hypothalamic-pituitary-adrenal and renin-angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress. J Clin Endocrinol Metab 1987; 64: 986–94.
Plein JB, Plein EM. Pharmacokinetics and pharmacodynamics in the geriatric patient.In: Krechel SW (Eds.). Anesthesia and the Geriatric Patient. Orlando: Grune & Stratton, 1984;. 74–98.
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This work was supported by a grant from the Ministry of Health and Welfare of Japan.
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Furuya, K., Shimizu, R., Hirabayashi, Y. et al. Stress hormone responses to major intra-abdominal surgery during and immediately after sevoflurane-nitrous oxide anaesthesia in elderly patients. Can J Anaesth 40, 435–439 (1993). https://doi.org/10.1007/BF03009513
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DOI: https://doi.org/10.1007/BF03009513