Effect of Patient-Controlled Analgesia on Plasma Catecholamine, Cortisol and Glucose Concentrations After Cholecystectomy

Møller, I. W.; Dinesen, K; Søndergård, Stine Dam; Knigge, Ulrich; Kehlet, Henrik

doi:10.1093/bja/61.2.160

Cited by 58 publications

(19 citation statements)

References 22 publications

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“…Perioperative catecholamine and cortisol levels increase with general anesthesia, anesthetic reversal, extubation, increasing pain scores, increasing grades of surgical trauma, anemia, fasting and hypothermia. [45][46][47][48][49][50] Increased stress hormone levels result in increases in blood pressure, heart rate, coronary artery sheer stress, relative insulin deficiency and free fatty acid levels. 33,50,51 Coronary artery shear stress may trigger plaque fissuring and acute coronary thrombosis.…”

Section: Triggers Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Devereaux

Goldman

Cook

et al. 2005

CMAJ

581

350

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THIS IS THE FIRST OF 2 ARTICLES EVALUATING cardiac events in patients undergoing noncardiac surgery. In this article, we review the magnitude of the problem, the pathophysiology of these events, approaches to risk assessment and communication of risk. The number of patients undergoing noncardiac surgery worldwide is growing, and annually 500 000 to 900 000 of these patients experience perioperative cardiac death, nonfatal myocardial infarction (MI) or nonfatal cardiac arrest. Although the evidence is limited, a substantial proportion of fatal perioperative MIs may not share the same pathophysiology as nonoperative MIs. A clearer understanding of the pathophysiology is needed to direct future research evaluating prophylactic, acute and long-term interventions. Researchers have developed tools to facilitate the estimation of perioperative cardiac risk. Studies suggest that the Lee index is the most accurate generic perioperative cardiac risk index. The limitations of the studies evaluating the ability of noninvasive cardiac tests to predict perioperative cardiac risk reveals considerable uncertainty as to the role of these popular tests. Similarly, there is uncertainty as to the predictive accuracy of the American College of Cardiology / American Heart Association algorithm for cardiac risk assessment. Patients are likely to benefit from improved estimation and communication of cardiac risk because the majority of noncardiac surgeries are elective and accurate risk estimation is important to allow informed patient and physician decision-making

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Section: Triggers Of Perioperative Myocardial Infarctionmentioning

confidence: 99%

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Devereaux

Goldman

Cook

et al. 2005

CMAJ

581

350

View full text Add to dashboard Cite

show abstract

“…Medications that reduce pain and distress such as analgesics,[11] corticosteroids, morphine[12] and anesthetics[1314] following surgery can directly help reduce treatment-related distress, improve functional well being and reduce consequent immune suppression. However, such medications are not always cost-effective and have side effects ranging from gastrointestinal distress, nausea and, sleep disturbances[10] and also excessive use can dampen both innate and anti-tumor immune responses.…”

mentioning

confidence: 99%

Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery

et al. 2008

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Context:Breast cancer patients awaiting surgery experience heightened distress that could affect postoperative outcomes.Aims:The aim of our study was to evaluate the effects of yoga intervention on mood states, treatment-related symptoms, quality of life and immune outcomes in breast cancer patients undergoing surgery.Settings and Design:Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited for a randomized controlled trial comparing the effects of a yoga program with supportive therapy plus exercise rehabilitation on postoperative outcomes following surgery.Materials and Methods:Subjects were assessed prior to surgery and four weeks thereafter. Psychometric instruments were used to assess self-reported anxiety, depression, treatment-related distress and quality of life. Blood samples were collected for enumeration of T lymphocyte subsets (CD4 %, CD8 % and natural killer (NK) cell % counts) and serum immunoglobulins (IgG, IgA and IgM).Statistical Analysis Used:We used analysis of covariance to compare interventions postoperatively.Results:Sixty-nine patients contributed data to the current analysis (yoga n = 33, control n = 36). The results suggest a significant decrease in the state (P = 0.04) and trait (P = 0.004) of anxiety, depression (P = 0.01), symptom severity (P = 0.01), distress (P < 0.01) and improvement in quality of life (P = 0.01) in the yoga group as compared to the controls. There was also a significantly lesser decrease in CD 56% (P = 0.02) and lower levels of serum IgA (P = 0.001) in the yoga group as compared to controls following surgery.Conclusions:The results suggest possible benefits for yoga in reducing postoperative distress and preventing immune suppression following surgery.

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“…Additionally, it has been suggested that epidural analgesia provided by local anesthetics or morphine should continue during the postoperative period to reduce the stress response at the maximum level (23).…”

Section: Discussionmentioning

confidence: 99%

Effects of epidural morphine and levobupivacaine combination before incision and after incision and in the postoperative period on thoracotomy pain and stress response

Barut¹,

Tunç²,

Şahin³

et al. 2018

Turk J Med Sci

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Background/aim: This study aims to investigate the effects of thoracic epidural analgesia, before and after surgical incision and in the postoperative period, on thoracotomy pain and stress response. Materials and methods:A total of 45 patients who were scheduled for posterolateral thoracotomy were included in this study. A combination of epidural levobupivacaine and morphine was administered as a bolus before incision (Group 1; n=15), after incision (Group 2; n=15), or at the end of surgery (Group 3; n=15). Additionally, infusion was used in Group 1 and Group 2 during operation. Postoperative patient-controlled epidural analgesia infusion pumps were connected to all patients. Visual analog scale (VAS) scores and morphine consumption were recorded during the postoperative 48 h. Glucose, insulin, cortisol, and C-reactive protein (CRP) levels were compared before surgery and at 4, 24, and 48 h after the operation.Results: There were no differences in the morphine consumption and VAS scores for all measurements among the groups (P > 0.05). Both blood glucose levels at 4 h and CRP values at 48 h were higher in Group 2 than Group 1 (P < 0.05). Cortisol levels at 4, 24, and 48 h after the operation were similar to baseline values in all groups (P > 0.05). Conclusion:The application of thoracic epidural analgesia before and after surgical incision and in the postoperative period did not result in a significant difference in the severity of the postthoracotomy pain and stress response in all groups. Based on our results, we suggest that epidural levobupivacaine combined with morphine provides an effective and safe analgesia and can partially suppress surgical stress response.

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Effect of Patient-Controlled Analgesia on Plasma Catecholamine, Cortisol and Glucose Concentrations After Cholecystectomy

Cited by 58 publications

References 22 publications

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk

Influence of yoga on mood states, distress, quality of life and immune outcomes in early stage breast cancer patients undergoing surgery

Effects of epidural morphine and levobupivacaine combination before incision and after incision and in the postoperative period on thoracotomy pain and stress response

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