Summary and Conclusions
Serial assays of plasma cortisol concentrations were carried out before, during, and after major surgical procedures in 68 patients, employing halothane and methoxyflurane as the primary anaesthetic agents. A simple fluorimetric assay procedure was used which provided accurate data rapidly.
Synacthen® (synthetic β 1–24 corticotropin) was employed in place of natural ACTH as a chemical stimulus of the adrenal cortex and was found to be an effective and safe test of the patients’ response to stress. No immunological reactions occurred with this preparation.
Atropine and meperidine premedication did not affect the response to the test. The initial rise in the plasma cortisol levels after induction of anaesthesia was slower than that produced by the injection of β 1–24 corticotropin, probably due to the administration of thiopentone during induction of anaesthesia.
The plasma cortisol levels rose to quite high levels during surgical operations with methoxyflurane anaesthesia when synthetic β 1–24 corticotropin was administered, whereas they were somewhat depressed when halothane anaesthesia was employed. However, there was no striking difference between the two anaesthetics and surgery when no β 1–24 corticotropin was given.
The significance of the plasma cortisol level with respect to circulatory homeostasis is not known, but an adequate level appears to be essential during induction of anaesthesia and the performance of major surgery. Elderly patients had the same general response on the plasma cortisol level during anaesthesia and surgery as younger patients, and there were no apparent differences due to the sex of the patient provided adrenocortical insufficiency was not present.
This test may be particularly useful in patients who have received steroid therapy in the past, in order to determine whether they require supportive therapy during an operation.
Résumé
Nous avons fait des recherches en série pour déterminer dans le plasma les concentrations en cortisol avant, pendant et après des opérations majeures chez 68 malades chez qui le principal agent anesthésique était ou l’halothane ou le méthoxyflurane. Nous avons fait un simple test fluorimétrique, test qui donne des résultats précis rapidement.
A la place de l’ACTH naturelle comme stimulant chimique du cortex surrénalien, nous avons utilisé la Cortrosyn® (corticotropine β 1–24 synthétique), produit qui s’est avéré efficace et de toute sécurité pour évaluer la réponse des malades à l’agression. Avec ce produit, nous n’avons observé aucune réaction immunologique.
La prémédication à la mépéridine et à l’atropine n’a pas modifié la réponse au test. L’élévation initiale dans le plasma des taux de cortisol après l’induction de l’anesthésie a été plus lente que celle produite par l’injection de β 1–24 corticotropine, probablement à cause de l’administration de thiopental au cours de l’induction de l’anesthésie.
Les taux de cortisol plasmatique ont atteint des niveaux plutôt élevés au cours des opérations faites sous anesthésie au méthoxyflurane lorsque nous injections de la β 1–24 corticotropine synthétique alors qu’ils étaient plutôt abaissés au cours de l’anesthésie à l’halothane. Toutefois, lorsque nous ne donnions pas de β 1–24 corticotropine, nous n’avons pas observé de différence marquée entre les deux agents anesthésiques et la chirurgie.
Nous ne connaissons pas la signification du taux de cortisol plasmatique en ce qui concerne l’homéostase circulatoire, mais, pour faire l’induction de l’anesthésie et pour pratiquer la chirurgie, il nous semble essentiel que le malade en ait un taux adéquat.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Wyant, G. M.;Longmore, A. J.; &Weder, C. H. The Adrenal Cortex. Canad. Anaesth. Soc. J.5: 2 (1958).
Jenkins, D.;Forsham, P. H.;Laidlaw, J. C;Reddy, W. J.; &Thorn, G. W. Use of ACTH in the Diagnosis of Adrenal Cortical Insufficiency. Am. J. Med.17: 3 (1955).
Johnston, I. D. A. Endocrine Aspects of the Metabolic Response to Surgical Operation. Ann. Roy. Coll. Surg. Engl.35: 270 (1964).
Mattingly, D. A Simple Fluorimetric Method for the Estimation of Free 11-hydroxycorticosteroids in Human Plasma. J. Clin. Path.15: 374 (1962).
James, V. H. T.;Townsend, J.; &Fraser, R. Comparison of Fluorimetric and Isotropic Procedures for the Determination of Plasma Cortisol. J. Endocr.37: 28 (1967).
Schuler, W.;Schar, B.; &Desaulles, P. Zur Pharmakologie eines ACTH-wirksamen, vollsynthetischen Polypeptides, des β 1-24-Corticotropins, Ciba 30920-Ba, Synacthen. Schweiz. med. Wchnschr.93: 1027 (1963).
Karl, H. J. Adrenocorticotrope Wirkung eines vollsynthetische Tetracosapeptides beim Menschen. Klin. Wchnschr.41: 633 (1963).
Jenny, M.;Muller, A. F.; &Mach, R. S. Effects cliniques et métaboliques d’un nouveau polypeptide à action adrénocorticotrope (tetracosapeptide). Schweiz. med. Wchnschr.93: 766 (1963).
Landon, J.;James, V. H. T.;Cryer, R. J.;Wynn, V.; &Frankland, A. W. Adreno-corticotropic Effects of a Synthetic Polypeptide β 1-24-Corticotropin in Man. J. Clin. Endocr.24: 1206 (1964).
Ohlsen, P. &Hockfelt, B. Effect of Synthetic ACTH on Steroid Hormone Production in Man. Acta med. scandinav.177: 25 (1965).
Greig, W. R.;Browning, M. C. K.;Boyle, J. A.; &Maxwell, J. D. Effect of the Synthetic Polypeptide β 1-24 (Synacthen) on Adrenocortical Function. J. Endocr.34: 411 (1966).
Arguelles, A. E.;Chekherdemian, M.;Ricca, A.; &Gardinali, D. P. Effect of a New Synthetic Tetracosapeptide on the Cortisol Levels and Aldosterone, Dehydroepianthrosterone and Catecholamine Excretion. J. Clin. Endocr.24: 1277 (1964).
Lebowitz, H. &Engel, F. L. Relationship Between the Structure and Biological Activities of Corticotropin and Related Petpides. Metabolism.13: 1230 (1964).
El-Shaboury, A. H. Effect of a Synthetic Corticotrophic Polypeptide on Adrenal Function in Hypersensitive Asthmatics. Lancet1: 298 (1965).
Ennis, G.;Gordon, R.; &Hudson, B. A Synthetic Polypeptide (Ciba 30, 920-Ba) with Adrenocorticotrophic Properties. Med. J. Aust.1: 590 (1964).
Imura, H.;Sparks, L. L.;Grodsky, G. M.; &Forsham, P. H. Immunologie Studies of Adrenocorticotropic Hormone (ACTH); Dissociation of Biologic and Immunologie Activities. J. Clin. Endocr.25: 1361 (1965).
Lamberg, B. A.;Strandstrom, L.; &Personen, S. The Effect of a Synthetic β 1-24 Eikosatetrapeptide Corticotropin (30, 920-Ba Ciba) on Plasma Corticoids and the Urinary 17-KS and 17-OHCS. Acta med. scandinav.179: 551 (1966).
Buytendijk, H. J. &Maesen, Fr. Comparative Skin Tests with Animal and Synthetic Corticotrophin in Patients Hypersensitive to Animal Corticotrophin. Acta Endocr.47: 613 (1964).
Zarate, O. &Quinteros, H. Preliminary Report on the Therapeutic Use of a Synthetic Corticotrophin. J. Allerg.38: 51 (1966).
Charpin, J.;Zafiropoulo, A.;Aubert, J.;Ohresser, P.; &Boutin, C. Données Actuelles Concernant l’Allergie à l’ACTH. Press. Med.72: 3025 (1964).
Wood, J. B.;James, V. H. T.;Frankland, A. W.; &Landon, J. A Rapid Test of Adrenocortical Function. Lancet.1: 243 (1965).
Moncloa, F.;Velezco, I.; &Gutierrez, L. One-hour Intravenous ACTH Test. J. Clin. Endocr. and Metab.26: 482 (1966).
Alleyne, G. A. O. &Young, V. H. Test of Adrenocortical Reserve in Children. Lancet.2: 503 (1966).
Nilsson, E.;Arner, B.; &Hedner, P. Corticosteroid Concentration in Plasma during Anaesthesia and at Operation. Acta chir. scandinav.126: 281 (1963).
Bursten, B. &Russ, J. J. Preoperative Psychological Stress and Corticosteroid Levels of Surgical Patients. Psychosomatic Med.27: 309 (1965).
Oyama, T.et al. Effects of Halothane Anesthesia and Surgical Operation on Adrenocortical Function. Japan J. Anesth.16: 361 (1967).
Shibata, S.;Matsumoto, F.;Takiguchi, M.; &Kudo, T. Effects of Methoxyflurane Anesthesia and Surgical Operation on Adrenocortical Function. Japan J. Anesth.16: 983 (1967).
Dobkin, A. B.;Byles, P. H.; &Neville, J. F., Jr. Neuroendocrine and Metabolic Effects of General Anaesthesia and Graded Haemorrhage. Canad. Anaesth. Soc. J.13: 453 (1966).
Virtue, R. W.;Helmreich, M. L.; &Gainza, E. The Adrenocortical Response to Surgery: I. The Effect of Anesthesia on Plasma 17 Hydroxycorticosteroid Levels. Surgery.41: 549 (1957).
Hammond, W. G.;Vandam, L. D.;Davis, J. M.;Carter, R. D.;Ball, M. R.; &Moore, F. D. Studies in Surgical Endocrinology: IV. Anesthetic Agents as Stimuli to Change in Corticosteroids and Metabolism. Ann. Surg.148: 199 (1958).
Dobkin, A. B.;Heinrich, R. G.;Israel, J. S.;Levy, A. A.;Neville, J. F., Jr.; &Ounkasem, K. Clinical and Laboratory Evaluation of a New Inhalation Agent: Compound 347 (CHF2-O-CF2-CHFCl). Anesthesiology.29: 275 (1968).
Bassøe, H. H.;Aarskog, D.;Thorssen, T.; &Støa, K. F. Cortisol Production Rate in Patients with Acute Bacterial Infection. Acta med. scandinav.177: 701 (1965).
Egdahl, R. H. Cerebral Cortical Inhibition of Pituitary-Adrenal Secretion. Endocrinology.68: 574 (1961).
Maniey, J. Agresions et hypokaliémie chez le rat: II. Rôle de l’hypophyse et de la surrénale dans rhypokaliémie provoquée par une agression non spécifique. T. Physiol. (Paris).57: 447 (1965).
Luft, R.et al. Effect of a Small Decrease in Blood-Glucose on Plasma Growth Hormone and Urinary Excretion of Catecholamines in Man. Lancet.2: 254 (1966).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nlshioka, K., Levy, A.A. & Dobkin, A.B. Effect of halothane and methoxyflurane anaesthesia on plasma cortisol concentration in relation to major surgery. Can. Anaes. Soc. J. 15, 441–457 (1968). https://doi.org/10.1007/BF03003729
Issue Date:
DOI: https://doi.org/10.1007/BF03003729