Effects of sevoflurane anesthesia and surgery on anterior pituitary and adrenocortical function in man
Murakawa, T.; Satoh, Y.; Kudo, T.; Kudo, M.; Matsuki, A.; Oyama, T.
Masui. Japanese Journal of Anesthesiology 36(7): 1058-1063
1987
ISSN/ISBN: 0021-4892 PMID: 2824874 Document Number: 290168
Effects of sevoflurane-nitrous oxide-oxygen anesthesia and surgery on plasma cortisol, aldosterone and ACTH levels were evaluated in twenty four patients, aged 15 to 62, who underwent orthopedic surgery or abdominal surgery (gastrointestinal or gynecological surgery). Anesthesia was induced and maintained with sevoflurane,a new fluorinated inhalation agent, nitrous oxide and oxygen. Succinylcholine was administered to facilitate tracheal intubation and pancuronium was given during abdominal surgery when needed. Lactated Ringer's solution was administered intravenously throughout the procedures. Sevoflurane anesthesia alone for 20 min did not affect the plasma levels of cortisol, aldosterone and ACTH. In patients who underwent non-abdominal surgery, plasma levels of cortisol and ACTH were unchanged during surgery, but they tended to increase gradually and reached the peak value after the recovery from anesthesia. However, plasma aldosterone levels significantly increased with surgical stimulation and reached the peak value in the recovery room. In those patients who underwent abdominal surgery, plasma levels of cortisol, aldosterone and ACTH increased significantly with surgical stimulation and reached the peak value in the recovery room. Plasma levels of cortisol, aldosterone and ACTH during surgery and after the recovery from anesthesia were significantly higher in patients undergoing abdominal surgery than in those undergoing nonabdominal surgery. The author's finding suggests that the magnitude of surgical stress is larger with abdominal intervention than with orthopedic surgery, and this is reflected in the quantitative difference in the anterior pituitary and adrenocortical responses judged by plasma concentrations of ACTH, cortisol and aldosterone. Furthermore, the influence of surgical stress appears to induce stronger hormonal response than that of sevoflurane anesthesia. In comparison with other investigated inhalation anesthetic agents such as halothane and enflurane, no appreciable difference was detected in this study.