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Influence of Stress on the Endocrine System and Nutritional Support in Surgical Patients

  • W. Behrendt
Conference paper

Abstract

During the past 20 years, the problems of posttraumatic metabolism and artificial nutrition support have met with increasing interest since the advances in surgery, anaesthesiology and intensive care medicine have made possible surgical interventions which require prolonged postoperative artificial nutrition, e.g. major tumour surgery of the abdomen or of the oro- and hypopharynx.

Keywords

Nitrogen Balance Nitrogen Loss Glucagon Concentration Counterregulatory Hormone Parenteral Nutrition Support 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Äärimaa M, Syvälahti E, Viikari J, Ovaska J (1978) Insulin, growth hormone and catecholamines as regulators of energy metabolism in the course of surgery. Acta Chir Scand 144:411–422 (1978)PubMedGoogle Scholar
  2. Allison SP, Tomlin PJ, Chamberlain MJ (1969) Some effects of anaesthesia and surgery on carbohydrate and fat metabolism. Br J Anaesth 41:588–593PubMedCrossRefGoogle Scholar
  3. Barton RN, Passingham BJ (1981) Effect of binding to plasma proteins on the interpretation of plasma Cortisol concentrations after accidental injury. Clin Sci 61:399–405PubMedGoogle Scholar
  4. Baue AE, Bernulf G, Hartl W, Ackenheil M, Heberer G (1984) Altered hormonal activity in severely ill patients after injury or sepsis. Arch Surg 119:1125–1132PubMedGoogle Scholar
  5. Behrendt W (1987) Zur Zuverlässigkeit von Schätzungen des Energieverbrauchs polytraumatisierter und langzeitbeatmeter Patienten. Akt Chir 22:169–200Google Scholar
  6. Behrendt W, Minale C, Giani G (1984) Parenterale Ernährung nach herzchirurgischen Operationen. Infusionstherapie 11:316–322Google Scholar
  7. Behrendt W, Raumanns J, Hanse J, Giani G (1988) Glucose, fructose, and xylitol in postoperative hypocaloric parenteral nutrition. Infusionstherapie 15:170–175PubMedGoogle Scholar
  8. Behrendt W, Bogatz V, Giani G (1990) The influence of posttraumatic calorie and nitrogen supply upon cumulative nitrogen balance. Infusionstherapie 17 (in press February 1990)Google Scholar
  9. Bernard C (1877) Leçons sur le diabète et la glycogénèse animale. Baillère, Paris, p 210Google Scholar
  10. Bessey PQ, Watters JM, Aoki TT, Wilmore DW (1984) Combined hormonal infusion simulates the metabolic response to injury. Ann Surg 200:264–280PubMedCrossRefGoogle Scholar
  11. Birke G, Carlson LA, von Euler US, Liljedahl S-O, Plantin I-O (1972) Studies on burns. XII. Lipid metabolism, catecholamine excretion, basal metabolic rate, and water loss during treatment of burns with warm dry air. Acta Chir Scand 138:321–333PubMedGoogle Scholar
  12. Black PR, Brooks DC, Bessey PQ, Wolfe RR, Wilmore DW (1982) Mechanisms of insulin resistance following injury. Ann Surg 196:420–435PubMedCrossRefGoogle Scholar
  13. Brandi LS, Oleggini M, Lachi S, Frediani M, Belvilacqua, Mosca F, Ferrannini E (1988) Energy metabolism of surgical patients in the early postoperative period: a reappraisal. Crit Care Med 16:18–22PubMedCrossRefGoogle Scholar
  14. Brandt MR, Fernandes A, Mordhorst R, Kehlet H (1978) Epidural analgesia improves postoperative nitrogen balance. Br Med J 1:1106–1108PubMedCrossRefGoogle Scholar
  15. Bromage PR, Shibata HR, Willoughby HW (1971) Influence of prolonged epidural blockade on blood sugar and Cortisol responses to operations upon the upper part of the abdomen and the thorax. Surg Gynecol Obstet 132:1051–1056PubMedGoogle Scholar
  16. Brown III FF, Owens WD, Felts JA, Spitznagel EL, Cryer PE (1982) Plasma epinephrine and norepinephrine levels during anesthesia: Enflurane-N2O-O compared with Fentanyl-N2O-O2. Anesth Analg 61:366–370PubMedGoogle Scholar
  17. Bürger M, Grauhan M (1922) Über postoperativen Eiweißzerfall. I. Z Ges Exp Med 27:97–114CrossRefGoogle Scholar
  18. Bürger M, Grauhan M (1923) Über postoperativen Eiweißzerfall. II. Mitteilung. Die postoperative Azoturie. Z Ges Exp Med 35:16–42CrossRefGoogle Scholar
  19. Bürger M, Grauhan M (1924) Über postoperativen Eiweißzerfall. III. Mitteilung. Die postoperative Azotämie. Z Ges Exp Med 42:345–373CrossRefGoogle Scholar
  20. Bürger M, Grauhan M (1927) Der postoperative Eiweißzerfall, sein Nachweis und seine Bedeutung. Klin Wschr 6:1767–1769CrossRefGoogle Scholar
  21. Cerra FB, Siegel JH, Coleman B, Border JR, Mc Menamy RR (1980) Septic autocannibalism. A Failure of exogenous nutritional support. Ann Surg 570–579Google Scholar
  22. Chiolero R, Schutz Y, Lemarchand TH, Felber JP, De Tribolet N, Freeman J, Jequiers E (1989) Hormonal and metabolic changes following severe head injury or noncranial injury. J Parent Ent Nutr 13:5–12CrossRefGoogle Scholar
  23. Christensen P, Brandt MR, Rem J, Kehlet H (1982) Influence of extradural morphine on the adrenocortical and hyperglycaemic response to surgery. Br J Anaesth 54:23–27PubMedCrossRefGoogle Scholar
  24. Cuthbertson DP (1930) The disturbance of metabolism produced by bony and non-bony injury, with notes on certain abnormal conditions of bone. Biochem J 24:1244–1263PubMedGoogle Scholar
  25. Cuthbertson DP (1932) Observation on the disturbance of metabolism produced by injury to the limbs. Quart J Med 25:223–246Google Scholar
  26. Davies JWL, Lamke L-O, Liljedahl S-O (1977) Pathophysiology and treatment of patients with burns covering 30–60% of the body surface. Acta Chir Scand (Suppl) 468:5–23Google Scholar
  27. Davies JWL, Lamke L-O, Liljedahl S-O (1977) Metabolic studies during the successful treatment of three adult patients with burns covering 80–85% of the body surface. Treatment of severe burns. Acta Chir Scand (Suppl) 468:25–60Google Scholar
  28. Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE (1968) Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 64:134–142PubMedGoogle Scholar
  29. Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE (1969) Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? An affirmative answer. Ann Surg 169:974–984PubMedCrossRefGoogle Scholar
  30. Dudrick SJ, McFadyen BV, van Buren CT, Ruberg RL, Maynard AT (1972) Parenteral hyperalimentation. Metabolic problems and solutions. Ann Surg 176:259–264PubMedCrossRefGoogle Scholar
  31. Engelman RM, Haag B, Lemeshow St, Angelo A, Rousou JH (1983) Mechanism of plasma catecholamine increases during coronary artery bypass and valve procedure. J Thorac Cardiovasc Surg 86:608–615PubMedGoogle Scholar
  32. Gelfant RA, Matthews DE, Bier DM, Sherwin RS (1984) Role of counterregulatory hormones in the catabolic response to stress. J Clin Invest 74:2238–2248CrossRefGoogle Scholar
  33. Georgieff M, Kattermann R, Geiger K et al (1981) Vergleich von Xylit und Glukose als Energieträger im Rahmen der hypokalorischen postoperativen parenteralen Ernährungstherapie. Infusionstherapie 8:69–76Google Scholar
  34. Hagen C, Brandt MR, Kehlet H (1980) Prolactin, LH, FSH, GH and Cortisol response to surgery and the effect of epidural analgesia. Acta Endocrinol 94:151–154PubMedGoogle Scholar
  35. Haider W, Benzer H, Krystof G et al (1975) Urinary catecholamine excretion and thyroid hormone blood level in the course of severe acute brain damage. Europ J Intensive Care Medicine 1:115–123CrossRefGoogle Scholar
  36. Hjortsø N-C, Christensen NJ, Andersen T, Kehlet H (1985) Effects of the extradural administration of local anaesthetic agents and morphine on the urinary excretion of Cortisol, catecholamines and nitrogen following abdominal surgery. Br J Anaesth 57:400–406PubMedCrossRefGoogle Scholar
  37. Hörnchen U, Schüttler J, Stoeckel H, Eichelkraut W (1988) Pharmakokinetik und Dynamik von endogen freigesetztem und therapeutisch appliziertem Adrenalin unter Reanimationsbedingungen. Anaesthesist 37:615–619PubMedGoogle Scholar
  38. Johnston IDA (1973) The metabolic and endocrine response to injury: a review. Br J Anaesth 45:252–255PubMedCrossRefGoogle Scholar
  39. Jørgensen BC, Andersen HB, Engquist A (1982) Influence of epidural morphine on postoperative pain, endocrine-metabolic, and renal response to surgery. A controlled study. Acta Anaesth Scand 26:63–68PubMedCrossRefGoogle Scholar
  40. King LR, McLaurin RL, Lewis HP, Knowles HC (1970) Plasma Cortisol levels after head injury. Ann Surg 172:975–984PubMedCrossRefGoogle Scholar
  41. Kinney JM (1980) The application of indirect calorimetry to clinical studies. In: Kinney JM (ed) Assessment of energy metabolism in health and disease. Report of the First Ross Conference on Medical Research, pp 42–48, Ross Laboratories, Columbus, OhioGoogle Scholar
  42. Kinney JM (1983) Energy metabolism in adult clinical conditions. In: Kleinberger G, Deutsch E (eds) New aspects of clinical nutrition. Karger, Basel München Paris London New York Tokyo Sydney, pp 79–85Google Scholar
  43. Liddell MJ, Daniel AM, MacLean LD, Shizgal HM (1979) The role of stress hormones in the catabolic metabolism of shock. Surg Gynecol Obstet 149:822–830PubMedGoogle Scholar
  44. Liljedahl S-O (1978) Parenterale Ernährung und andere therapeutische Maßnahmen bei schweren Verbrennungen. In: Zöllner N (ed) Parenterale Ernährung. Beiträge zu Infusionstherapie und klinische Ernährung. Karger, Basel, München Paris London New York Sydney, pp 48–63Google Scholar
  45. Lindsey A, Santeusanio F, Braaten J, Faloona GR, Unger RH (1974) Pancreatic alpha-cell function in trauma. JAMA 227:757–761PubMedCrossRefGoogle Scholar
  46. Meguid MM, Brennan MF, Aoki TT, Muller WA, Ball MR, Moore FD (1974) Hormone-substrate interrelationships following trauma. Arch Surg 109:776–783PubMedGoogle Scholar
  47. Mullen JL, Buzby GP, Matthews DC, Smale BF, Rosato EF (1980) Reduction of operative morbidity and mortality by combined preoperative and postoperative nutritional support. Ann Surg 192:604–613PubMedGoogle Scholar
  48. Müller JM, Brenner U, Dienst C, Pichlmaier H (1982) Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet 1:68–71PubMedCrossRefGoogle Scholar
  49. Pasch Th, Brandl M, Köckerling F, von der Emde J (1981) Der Einfluß von Vasodilatatoren auf die Plasmakatecholamine bei koronarchirurgischen Eingriffen. Anaesthesist 30:144–145Google Scholar
  50. Pscheidl E, Pasch Th, Buheitel G, Mahlstedt J, Pichl J (1987) Einfluß der Verletzungsschwere polytraumatisierter Patienten auf metabolische und hormonelle Parameter. Intensivbehandlung 12:125–132Google Scholar
  51. Rawlinson WAL, Loach AB, Benedict CR (1978) Changes in plasma concentration of adrenalin and noradrenalin in anaesthetized patients during sodium-nitroprusside-induced hypothension. Br J Anaesth 50:937–943PubMedCrossRefGoogle Scholar
  52. Ross H, Johnston IDA, Welborn TA, Wright AD (1966) Effect of abdominal operation on glucose tolerance and serum levels of insulin, growth hormone and hydrocortisone. Lancet II 563–566CrossRefGoogle Scholar
  53. Rudberg H, Hakanson E, Anderberg B, Jorfeldt L, Martensson J, Schildt B (1984) Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery. Br J Anaesth 56:233–238CrossRefGoogle Scholar
  54. Rudman D, Fleischer AS, Kutner MH, Raggio JF (1977) Suprahypophyseal hypogonadism and hypothyroidism during prolonged coma after head trauma. J Clin Endocrinol Metab 45:747–754PubMedCrossRefGoogle Scholar
  55. Russell RCG, Walker CJ, Bloom SR (1975) Hyperglucagonaemia in the surgical patient. Br Med J 1:10–12PubMedCrossRefGoogle Scholar
  56. Sachs M, Asskali F, Förster H, Ungeheuer E (1988) Untersuchungen über den Postaggressionsstoffwechsel nach Laparotomien und Thorakotomien. Chirurg 59:24–33PubMedGoogle Scholar
  57. Schmitz JE (1985) Infusions- und Ernährungstherapie des Polytraumatisierten. Anaesthesiologie und Intensivmedizin, Bd 173. Springer, Berlin Heidelberg New York Tokyo, pp 53–59Google Scholar
  58. Seeling W, Altemeyer K-H, Berg S, Feist H, Schmitz JE, Schröder M, Ahnefeld FW (1982) Die kontinuierliche thorakale Periduralanaesthesie zur intra- und postoperativen Analgesie. Anaesthesist 31:439–448PubMedGoogle Scholar
  59. Shamoon H, Hendler R, Sherwin RS (1981) Synergistic interactions among antiinsulin hormones in the pathogenesis of stress hyperglycemia in humans. J Clin Endocrinol Metab 52:1235–1241PubMedCrossRefGoogle Scholar
  60. Stanley Th, Berman L, Green O, Robertson D (1980) Plasma catecholamine and Cortisol responses to fentanyl-oxygen anaesthesia for coronary-artery operations. Anesthesiology 53:250–253PubMedCrossRefGoogle Scholar
  61. Stoner HB, Frayn KN, Barton RN, Threlfall CJ, Little RA (1979) The relationships between plasma substrates and hormones and the severity of injury in 277 recently injured patients. Crit Sci 56:563–573Google Scholar
  62. Traynor C, Paterson JL, Ward ID, Morgan M, Hall GM (1982) Effects of extradural analgesia and vagal blockade on the metabolic and endocrine response to upper abdominal surgery. Br J Anaesth 54:319–323PubMedCrossRefGoogle Scholar
  63. Vaughan GM, Becker RA, Allen JP, Goodwin CW, Pruitt BA, Mason AD (1982) Cortisol and corticotrophin in burned patients. J Trauma 22:263–273PubMedCrossRefGoogle Scholar
  64. Wilmore DW, Long JM, Mason AD, Skreen RW, Pruitt BA (1974) Catecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg 180:653–668PubMedCrossRefGoogle Scholar
  65. Wilmore DW, Lindsay CA, Moylan JA, Faloona GR, Pruitt BA, Unger RH (1974) Hyperglucagonaemia after burns. Lancet I 73–75CrossRefGoogle Scholar
  66. Wolfe RR, Durkot MJ, Allsop JR, Burke JF (1979) Glucose metabolism in severly burned patients. Metabolism 28:1031–1039PubMedCrossRefGoogle Scholar

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  1. Dahn MS, Lange P (1982) Hormonal changes and the influence on metabolism and nutrition in the critically ill. Intensive Care Med 8:209–213PubMedCrossRefGoogle Scholar
  2. Derbyshire DR, Smith G (1984) Sympathoadrenal responses to anaesthesia and surgery. Br J Surg 56:725–739Google Scholar
  3. Elliott M, Alberti KGMM (1983) The hormonal and metabolic response to surgery and trauma. In: Kleinberger G, Deutsch E (eds) New aspects of clinical nutrition. Karger, Basel München Paris London New York Tokyo Sydney, pp 247–270Google Scholar
  4. Gelfant RA, DeFronzo RA, Gusberg R (1983) Metabolic alterations associated with major injury or infection. In: Kleinberger G, Deutsch E (eds) New aspects of clinical nutrition. Karger, Basel München Paris London New York Tokyo Sydney, pp 211–239Google Scholar
  5. Stoner HB (1986) Metabolism after trauma and in sepsis. Circ shock 19:75–87PubMedGoogle Scholar
  6. Wilmore DW (1986) Are the metabolic alterations associated with critical illness related to the hormonal environment? Clinical Nutrition 5:9–19PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1990

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  • W. Behrendt

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