Mechanism of Plasma Catecholamine Increases During Surgical Stress in Man

Halter, Jeffrey B.; Pflug, A. Eugene; Porte, Daniel

doi:10.1210/jcem-45-5-936

Cited by 267 publications

(88 citation statements)

References 29 publications

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“…Various metabolic and nutritional impacts can be observed when serious injury is involved, with emphasis on water and sodium retention, potassium excretion, glucose intolerance, hyperglycemia, protein catabolism, and immune deficiency. 3,4,9,18 In recent decades, this picture has been further crowded by the identification of scores of other biologic and immunologic mediators. These predominantly include cytokines, but also chemokines, eicosanoids, opioids, acute phase proteins, coagulation factors, plasma complement fractions, and many others that may interact with or somehow modify expected responses.…”

Section: Discussionmentioning

confidence: 99%

“…Within the ensuing decades, a large cast of stress triggers was unveiled, including heat, cold, fear, anxiety, panic, trauma, surgery, sepsis, and other types of organic or mental aggression. [3][4][5][6][7] At the same time that Selye and others were interested in the endocrinologic and neurophysiologic consequences of stress in physically healthy subjects, 2 Cuthbertson was unknowingly investigating the same general question, but from the point of view of nutritional and metabolic repercussions after severe injury. 8 It was the subsequent initiative of Moore that brought together the various angles of this polygon for hospitalized patients.…”

mentioning

confidence: 99%

“…[3][4][5][6][7] In fact, multiple other mechanisms and mediators may be involved in surgical and septic hypermetabolism and protein catabolism. Individual responses are so varied that even the best calculations occasionally miss the point, rendering it necessary to employ indirect calorimetry, nitrogen balance, and other cumbersome diagnostic tools.…”

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confidence: 99%

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Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

et al. 2004

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A cross-sectional study of 120 subjects was performed with the purpose of evaluating stress hormones and emotional stress (anxiety) in outpatient and hospitalized subjects. The aims were to determine the degree of objective stress, as well as to correlate this finding with subjective findings, estimated using Beck´s Anxiety Inventory.. METHOD: Three populations were investigated, namely outpatient clinical cases (Group I, n = 30), hospitalized clinical individuals (Group II, n = 30), and hospitalized surgical candidates (Group III, n = 30). Controls (Group IV, n = 30) were healthy volunteers who were health-care professionals and students. To avoid hormone interactions, only men were enrolled in all groups. All hospitalized subjects were tested on admission and before therapeutic interventions. Fasting epinephrine, norepinephrine, and cortisol were measured in the morning, and Beck´s Anxiety Inventory was adminstered by a trained psychologist. RESULTS:The 3 patient groups displayed higher anxiety levels than the controls. Hormone concentrations did not present remarkable changes and did not correlate with subjective stress (anxiety).CONCLUSIONS: 1) Subjective disorders (as determined with Beck´s Anxiety Inventory ) were a common finding in both outpatient and hospitalized populations, without differences between the various groups; 2) Objective stress (as determined by elevated hormone levels) was more difficult to confirm-findings rarely exceeded the reference range; 3) Correlation between the two variables could not be demonstrated; 4) Further studies are necessary to define stress quantification and interpretation in patient populations, especially in relationship with nutritional diagnosis and dietetic prescription.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

et al. 2004

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“…Changes in circulating E reflect adrenal medullary activity, whereas changes in NE reflect the activity of the overall sympathetic nervous system. 31 The adrenergic response is related to the extent of surgical trauma and is caused by afferent signals (nociceptive pathways and humoral mediators) originating from the site of injury. 32 Neither of the anesthetics we tested could apparently inhibit such catecholamine activation.…”

Section: Discussionmentioning

confidence: 99%

Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery

Marana

Annetta

Meo

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Stress response to surgery is modulated by several factors, including magnitude of the injury, type of procedure (e.g., laparoscopy vs laparotomy) and type of anesthesia. Our purpose was to compare intra-and postoperative hormonal changes during isoflurane vs sevoflurane anesthesia, in a clinical model of well defined operative stress (laparoscopic pelvic surgery). M Me et th ho od d: :In this prospective randomized clinical study, 20 women requiring laparoscopic pelvic surgery for benign ovarian cysts received either a standard isoflurane plus fentanyl (Group A) or sevoflurane plus fentanyl anesthesia (Group B). Blood samples were collected preoperatively, 30 min after the beginning of surgery, at the end of surgery after extubation, and two and four hours after the end of surgery. Intra-and postoperative plasma levels of norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH) and prolactin (PRL) were measured. R Re es su ul lt ts s: : Catecholamine levels and postoperative pain were similar in both groups. Nonetheless, in comparison to Group A, Group B showed a significant decrease of ACTH, cortisol and GH levels (A vs B at the end of surgery: ACTH 160 ± 45 vs 100 ± 40 pg·mL -1 ; cortisol 45 ± 8 vs 23 ± 7 µg·dL -1 ; GH 3 ± 2 vs 0.8 ± 0.4 ng·mL -1 ; P < 0.001 for all), but enhanced PRL levels (A vs B, at 30 min after the beginning of surgery: 139 ± 54 vs 185 ± 22 ng·mL -1 ; at the end of surgery: 100 ± 27 vs 141 ± 45 ng·mL -1 ; P < 0.001 for both).C Co on nc cl lu us si io on ns s: : In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflurane. Objectif Méthode : L'étude clinique, prospective et randomisée, a été faite auprès de 20 femmes devant subir une intervention par laparoscopie pelvienne pour des kystes bénins de l'ovaire. Les patientes ont reçu, soit une anesthésie normale à l'isoflurane avec du fentanyl (groupe A), soit au sévoflurane avec du fentanyl (groupe B). Le sang a été prélevé avant l'opération, 30 min après le début, à la fin après l'extubation et, deux et quatre heures après l'opération. Les niveaux plasmatiques peropératoire et postopératoire de noradrénaline, d'adrénaline, d'hormone adrénocorticotrope (ACTH), de cortisol, d'hormone de croissance (GH) et de prolactine (PRL) ont été mesurés.Résultats : Les niveaux de catécholamine et la douleur postopéra-toire ont été similaires dans les deux groupes. Néanmoins, comparé au groupe A, le groupe B a affiché une baisse significative d' ACTH, GH 3 ± 2 vs 0,8 ± 0,

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“…Postoperative pain provokes an autonomic response that markedly increases adrenergic nerve activity and plasma catecholamine concentrations [101]. A consequence is arteriolar vasoconstriction.…”

Section: Pain Reliefmentioning

confidence: 99%

Non-pharmacologic Prevention of Surgical Wound Infection

Sessler

2006

Anesthesiology Clinics of North America

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Wound infections are serious and relatively common postoperative complications. They are generally detected five to nine days after surgery and are usually attributed, even by surgeons, to poor surgical technique or failure to maintain sterility. However, it has been known for decades that all wounds become contaminated, often by bacteria from the skin or within the patient, and that it is host defense mechanisms that prevent most contamination from developing into clinical infections. Host defense is especially important during the initial hours following contamination, i.e., the immediate perioperative period.As might thus be expected, factors that improve host defense reduce infection risk. Many of these are under the direct control of anesthesiologists and are at least as important as appropriate use of prophylactic antibiotics, which halve infection risk [1]. This article will review nonpharmacologic methods of reducing infection risk, with special emphasis on methods available to anesthesiologists.

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Mechanism of Plasma Catecholamine Increases During Surgical Stress in Man

Cited by 267 publications

References 29 publications

Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

Subjective versus objective stress in noncritically ill hospitalized and outpatient adult men

Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery

Non-pharmacologic Prevention of Surgical Wound Infection

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