Adrenocorticotropic Hormone (ACTH) and Cortisol Monitoring as Stress Markers During Laparoscopic Cholecystectomy: Standard and Low Intraabdominal Pressure and Open Cholecystectomy

Abstract

Introduction: In this study we wanted to examine the hormonal responses due to stress exposure during laparoscopic cholecystectomy with standard (12-15 mm / Hg) (LCSP) and low (6-8 mm / Hg) (LCLP) intraabdominal pressure and open cholecystectomy (OC), with particular emphasis on stress hormone responses. Aim: Determination of adrenocorticotropic hormone (ACTH) and cortisol stress hormones before and after laparoscopic cholecystectomy with standard and low insufflation pressure, determination of ACTH and cortisol values before and after open cholecystectomy and comparison of ACTH and cortisol values between the patient subgroups. Methods: In a prospective study conducted between July 2016 and February 2018, we involved 110 patients which were divided into two groups: 70 patients with laparoscopic cholecystectomy (LC) and 40 patients with open cholecystectomy (OC). The first group of patients was further divided into two subgroups of 35 patients, (subgroup LC with standard and subgroup LC with low intraabdominal pressure). All patients met the preset inclusion and exclusion criteria of the study. There were no statistically significant differences in the demographic characteristics of patients between the investigated groups. The stress hormones determined were adrenocorticotropic hormone (ACTH) and cortisol. Results: During the first, second and seventh day postoperative day (POD),ACTH values were significantly lower (p <0.0001) in LCLP than in LCSP and OC groups. This was also the case for comparison in LCSP and OC groups. By comparing LC and OC groups during first, the second and seventh POD, there was a significant difference (p <0.0001) in the ACTH levels. The concentration of this hormone was higher in the OC group in all three cases. The first, second and seventh POD were also statistically significant (p <0.0001) in cortisol values and between LC and OC groups there was an increase in cortisol levels in patients operated by open method. There was also a significant difference (p <0.0001) in cortisol values measured between LCLP and LCSP groups in the investigated days. Cortisol levels were higher in patients in the LCSP group. Conclusion: During open and laparoscopic cholecystectomy the response of the body to stress increased. The stress response of the organism during laparoscopic cholecystectomy was less than during open cholecystectomy. The stress response of the organism during laparoscopic cholecystectomy with low insufflation pressure (6-8mmHg) was less than during laparoscopic cholecystectomy with standard insufflation pressure (12-15mmHg).

Effects of deep neuromuscular block on surgical pleth index-guided remifentanil administration in laparoscopic herniorrhaphy: a prospective randomized trial

“…Laparoscopic hernia repair is associated with less tissue injury than open approach, and thus decreases the inflammatory stress response 26 . However, hormonal stress response (catecholamines and cortisol) might not be altered significantly than in open hernia repair, because the stimuli for stress response originate in the visceral and peritoneal afferent nerve as well as in the abdominal wall 25,27 . Further, the pneumoperitoneum significantly decreased the oxygenation and perfusion in abdominal organ, which is associated with the increased stress response 24,[27][28][29][30] .…”

“…However, hormonal stress response (catecholamines and cortisol) might not be altered significantly than in open hernia repair, because the stimuli for stress response originate in the visceral and peritoneal afferent nerve as well as in the abdominal wall 25,27 . Further, the pneumoperitoneum significantly decreased the oxygenation and perfusion in abdominal organ, which is associated with the increased stress response 24,[27][28][29][30] . Consequently, the sympathetic activation results in cardiovascular effects such as tachycardia and hypertension, thereby increasing the SPI values.…”

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“…Показники азотвидільної, водовидільної та електролітвидільної функцій нирок в 1-у добу післяопераційного періоду Таким чином, будь-яке лапароскопічне оперативне втручання на нирках неминуче супроводжується активацією ГГНС, яка забезпечує адаптаційно-компенсаторні реакції організму на операційну травму, які направлені на зменшення системного запалення і відновлення функцій оперованого органа [35]. Загальна анестезія блокує поширення ноцицептивної імпульсації від оперованого органу і попереджує психоемоційний компонент самого оперативного втручання, і, таким чином, зменшує аферентну стимуляцію ГГНС [40].…”

Endocrine Disorder in Patients With Craniopharyngioma

“…Adrenocorticotrophic hormone is a peptide hormone produced in the pituitary gland that stimulates the formation and secretion of adrenocortical glucocorticoids (especially cortisol) ( 65 ). In a non-stressed state, signs and symptoms of adrenal insufficiency may be so subtle that they are not recognized, but they may alternatively include anorexia, nausea, shakiness relieved by eating, hypoglycemia, poor weight gain, poor stamina, or easy fatigability ( 66 ).…”