Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms

Parikshak, Manesh; Shepard, Alexander D.; Reddy, Daniel J.; Nypaver, Timothy J.

doi:10.1016/j.jvs.2004.01.020

Cited by 8 publications

(25 citation statements)

References 35 publications

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“…Indeed, improvement in haemodynamic status as indicated by a decrease in cardiovascular SOFA score was only predicted by corticosteroid treatment in multivariate analysis, independently of ACTH test results. Lack of a mortality‐lowering effect in our patients otherwise agrees with the literature on stress doses of hydrocortisone in severe systemic inflammatory response syndrome after cardiac and vascular surgery, and trauma 9,10,27 …”

Section: Discussionsupporting

confidence: 90%

“…Our conclusions based on total cortisol levels are thus valid. We did not use the 1 µg ACTH test, allowing comparison with the extensive literature on the results of the 250 µg test, in the critically ill 1–6,9–13,18 . Patients with very low baseline cortisol values (< 100 nmol/l) were not excluded, as we were not able to attribute this to primary or secondary adrenal insufficiency in the absence of free cortisol measurements corrected for disease severity.…”

Section: Discussionmentioning

confidence: 99%

“…In response to the stress of critical illness, circulating levels of cortisol secreted by the adrenals are elevated. However, elevated levels of cortisol may be inappropriately low in some patients with critical illness, and this has been referred to as relative adrenal insufficiency (RAI), in which the adrenals do not respond sufficiently to additional stress stimuli 1–11 . RAI may be diagnosed with the help of the standard intravenous 250 µg ACTH stimulation test, in which baseline and peak cortisol levels, as well as increases in cortisol, are assessed.…”

Section: Introductionmentioning

confidence: 99%

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Relative adrenal insufficiency: an identifiable entity in nonseptic critically ill patients?

Jong

Beishuizen²,

Spijkstra³

et al. 2007

Clinical Endocrinology

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Relative adrenal insufficiency: an identifiable entity in nonseptic critically ill patients?

Jong

Beishuizen²,

Spijkstra³

et al. 2007

Clinical Endocrinology

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show abstract

“…In addition Keh and colleagues [42] showed that hydrocortisone restored haemodynamic stability and modulated the immunological response. These effects might also benefit RAAA patients since adrenal insufficiency can be identified in a significant amount of them [43]. The clinical effect of hydrocortisone suppletion in RAAA patients needs to be evaluated further.…”

Section: Discussionmentioning

confidence: 99%

HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

et al. 2006

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Introduction Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA and compare results between survivors and non-survivors. A similar comparison is made for IL-6 and IL-10 levels and Sequential Organ Failure Assessment (SOFA) scores.

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“…Persistent hypotension may be caused by adrenal insufficiency resulting from interruption of adrenal blood supply (suprarenal clamping), adrenal haemorrhage [107], or a systemic inflammatory response causing down-regulation of the hypothalamic-pituitary-adrenal axis. An unexpectedly high incidence was seen in one small study [107].…”

Section: Postoperative Managementmentioning

confidence: 99%

Anaesthesia for vascular emergencies

Ellard¹,

Djaiani

2012

Anaesthesia

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SummaryPatients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management. In-hospital mortality after open repair of ruptured abdominal aortic aneurysm (rAAA) approaches 40-50% with total mortality, including pre-hospital deaths, closer to 80% [1][2][3]. Traumatic thoracic aortic injury is often immediately fatal with a 30-40% mortality in those who arrive alive to hospital and an overall mortality of 90% [4]. Thirty-day mortality rates are > 50% following ruptured thoracic aneurysm [5], 13% for acute type B dissection [6] and > 25% following embolectomy for acute limb ischaemia [7,8].We define a 'vascular emergency', for the purpose of this review, as an acute condition requiring intervention within hours, involving the descending aorta and its main lower limb branches. Specific pathologies meeting these criteria include acute aortic syndrome, ruptured thoracic and abdominal aneurysms, traumatic injuries of the thoracic aorta and acute lower limb ischaemia. Pathology involving the ascending aorta or aortic arch that is generally managed by cardiac surgeons is excluded.This review aims to discuss the optimal anaesthetic management to minimise morbidity and mortality and the impact of a move towards endovascular repair. An English language electronic search using Medline and Embase databases identified relevant scientific literature from the last 10 years and was supplemented with a manual search of reference lists from reviewed articles. Overview of vascular emergenciesAcute aortic syndrome Acute aortic syndrome consists of three interrelated conditions: penetrating atherosclerotic ulcer; intramural haematoma; and aortic dissection. Penetrating athero-

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Adrenal insufficiency in patients with ruptured abdominal aortic aneurysms

Cited by 8 publications

References 35 publications

Relative adrenal insufficiency: an identifiable entity in nonseptic critically ill patients?

Relative adrenal insufficiency: an identifiable entity in nonseptic critically ill patients?

HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms

Anaesthesia for vascular emergencies

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