[Show abstract][Hide abstract] ABSTRACT: Patients undergoing trauma sustain an initial injury followed by further physiological challenges during surgery. Plasma osteocalcin (OC), a marker of osteoblastic activity, declines after major surgery. Increased cortisol secretion, and other components of the perioperative stress response, may play a role in mediating this response. We have examined the osteocalcin, hormonal and cytokine responses in twenty patients undergoing post-traumatic pelvic reconstruction surgery. We measured plasma osteocalcin, serum cortisol, bone specific alkaline phosphatase (BSAP), IL-6, IL-8, IL-10, plasma epinephrine and norepinephrine concentrations for up to 3 days after surgery. We recorded an increase in IL-6, IL-10 and epinephrine concentrations perioperatively and a fall in OC and BSAP concentrations. There were no significant changes in cortisol or IL-8 concentrations. Patients undergoing pelvic reconstruction surgery following trauma have a preserved inflammatory and catecholamine response but the cortisol response may be obtunded. Osteocalcin concentrations are affected by factors other than glucocorticoids.
[Show abstract][Hide abstract] ABSTRACT: Plasma osteocalcin, a marker of osteoblastic activity, decreases after major abdominal and gynaecological surgery. Increased cortisol secretion and other hormonal and inflammatory components of the peri-operative stress response may play a role in mediating this response. We assessed the effects of three different anaesthetic techniques on peri-operative osteocalcin concentrations. Thirty-six female patients undergoing elective total hip replacement were randomly assigned to receive propofol, propofol plus 'three-in-one' block or etomidate as part of a general anaesthetic technique. We measured plasma osteocalcin and serum cortisol, bone specific alkaline phosphatase, interleukin-6, plasma epinephrine, norepinephrine, plasma glucose and cystatin C concentrations for up to 3 days after surgery. Etomidate successfully inhibited the cortisol response to surgery but plasma osteocalcin declined in all patients. This was accompanied by increased plasma catecholamines, interleukin-6 and glucose concentrations, and decreased cystatin C-values. Inhibition of the cortisol response to surgery failed to prevent a decrease in plasma osteocalcin concentrations after surgery, suggesting that other factors such as cytokines or catecholamines may play a significant role.
[Show abstract][Hide abstract] ABSTRACT: We have compared the efficacy of adding varying concentrations of hyaluronidase to a standard mixture of 2% lidocaine and
1% ropivacaine to provide peribulbar anaesthesia for cataract surgery. We used (i) the time to adequate anaesthesia for surgery
and (ii) ocular and eyelid movement scores at 8 min after block as clinical endpoints. Ninety patients were randomly allocated
to receive 7–10 ml of equal volumes of 2% lidocaine and 1% ropivacaine without hyaluronidase or with hyaluronidase 15 IU ml–1or 150 IU ml–1. Median time at which the block was adequate for surgery was 6 min in all groups (interquartile range 4–12 min). Median eyelid
movement scores were similar in all groups, but the ocular movement scores at 8 min were significantly lower in the group
which received hyaluronidase 150 IU ml–1 than in the group not given hyaluronidase (P<0.03). There were no differences between groups in the incidence of minor complications. A high concentration of hyaluronidase
resulted in a statistically significantly lower ocular movement score at 8 min; the clinical relevance of this finding is
Br J Anaesth 2001; 86: 876–8
Preview · Article · Jun 2001 · BJA British Journal of Anaesthesia
[Show abstract][Hide abstract] ABSTRACT: We have compared the effects of dexmedetomidine and propofol on endocrine, metabolic, inflammatory and cardiovascular responses in patients in the intensive care unit (ICU) after major surgery. Twenty patients who were expected to require 8 h of post-operative sedation and ventilation were allocated randomly to receive either an infusion of dexmedetomidine 0.2-2.5 microg kg(-1) h(-1) or propofol 1-3 mg kg(-1) h(-1). Arterial pressure, heart rate and sequential concentrations of circulating cortisol, adrenocorticotrophic hormone (ACTH), growth hormone, prolactin, insulin, glucose and interleukin 6 were measured. An ACTH stimulation test was performed in all patients who received dexmedetomidine. Heart rate was significantly lower in the dexmedetomidine patients. There were no differences in arterial pressure, cortisol, ACTH, prolactin and glucose concentrations between the two groups. A positive response to the ACTH stimulation test varied depending on the diagnostic criteria used. The insulin concentration was significantly lower in the dexmedetomidine group at 2 h (P=0.021), although this did not affect blood glucose concentrations. Growth hormone concentrations were significantly higher in dexmedetomidine-treated patients overall (P=0.036), but circulating concentrations remained in the physiological range. Interleukin 6 decreased in the dexmedetomidine group. We conclude that dexmedetomidine infusion does not inhibit adrenal steroidogenesis when used for short-term sedation after surgery.
Preview · Article · Jun 2001 · BJA British Journal of Anaesthesia
[Show abstract][Hide abstract] ABSTRACT: It has been suggested that the incidence of early graft occlusion after arterial reconstructive surgery to the leg may be decreased by epidural analgesia. This effect may be mediated by the suppression of the usual cortisol response to surgery, which results in increased circulating plasminogen activator inhibitor-1 with consequent adverse effects on fibrinolysis. To investigate this and other potential mechanisms, 30 patients undergoing arterial reconstructive surgery to the leg were randomized to receive either general anaesthesia or general anaesthesia plus epidural analgesia. Post-operative analgesia was provided by morphine infusion or epidural analgesia, respectively. Blood samples were collected at 0, 2, 4, 6, 12 and 24 h, and 2, 3 and 5 days and analysed for cortisol, plasminogen activator inhibitor-1 antigen, interleukin-6 and beta thromboglobulin. The incidence of graft-related and systemic complications was recorded for 30 days. Only one patient developed early graft occlusion that required embolectomy and eventually amputation. There were no significant changes from control values in either group of patients in circulating cortisol, plasminogen activator inhibitor-1 and beta thrombogobulin (a marker for platelet degranulation). Interleukin-6 values increased significantly in both groups after 4 h and remained elevated until day 3. There were no significant differences between the groups in any variable measured. We conclude that any effect of epidural analgesia on early graft patency is unlikely to be mediated by fibrinolysis or platetlet degranulation.
Full-text · Article · Mar 2001 · BJA British Journal of Anaesthesia
[Show abstract][Hide abstract] ABSTRACT: Circulating osteocalcin is a good marker of osteoblastic activity and decreases significantly after stressful physiological
states such as major surgery. Glucocorticoids are known to inhibit osteoblastic activity and result in a decline in circulating
osteocalcin. We used etomidate to inhibit the cortisol response to routine gynaecological surgery to determine if this would
prevent the postoperative decline in osteocalcin. Twenty-four patients were allocated randomly to receive either thiopental
or etomidate for induction of anaesthesia; all other aspects of anaesthesia and perioperative management were standardized.
In the thiopental group, circulating cortisol increased significantly at 2 and 6 h after the start of surgery and plasma osteocalcin
concentrations decreased significantly to almost 50% of baseline values at 48 h. Etomidate abolished the cortisol response
to surgery, and circulating osteocalcin concentrations did not change after operation. There was a significant difference
in osteocalcin concentration between the groups at 48 h. We conclude that the cortisol response to surgery is associated with
a postoperative decrease in circulating osteocalcin.
Full-text · Article · Oct 1999 · BJA British Journal of Anaesthesia
[Show abstract][Hide abstract] ABSTRACT: The endocrine and immune changes associated with surgery are well documented, but the interaction between them has not been fully evaluated. Cortisol production during surgery can be suppressed by etomidate and we have used this to investigate the relationship between the cortisol response and immune changes in the perioperative period.
We have measured the cortisol, interleukin-6 and white cell responses to elective abdominal hysterectomy in 8 healthy female patients, who received etomidate 0.3 mg kg-1 for induction of anaesthesia. A control group of 8 subjects received thiopentone. Both groups of patients received vecuronium and fentanyl 2 micrograms kg-1 and anaesthesia was maintained with nitrous oxide in oxygen and isoflurane 0.5-1.0%. Venous blood samples were collected before and during surgery and up to 24 h in the postoperative period.
Serum interleukin-6 values were significantly greater at 6 and 12 h (P < 0.05) in those patients who received etomidate. Inhibition of the serum cortisol response to surgery in the etomidate group was also associated with less marked lymphopenia at 4 h (P < 0.05). There was no significant difference in neutrophil granulocyte counts between the two groups.
In conclusion, endogenous corticosteroids modulate the interleukin-6 response to surgery.
No preview · Article · Mar 1997 · Acta Anaesthesiologica Scandinavica