Abstract
The hormonal responses to anaesthesia and cardiac surgery were studied in patients undergoing valve or coronary bypass surgery. Marked increases in antidiuretic hormone levels as a result of surgical stress were seen, and were of approximately equal magnitude in both groups. Although both groups also showed marked increases in plasma cortisol levels in response to operations, this response appeared to be relatively blunted in valve surgery patients, especially at the end of operation and in the intensive care unit. This blunted cortisol response may be a manifestation of exhaustion of adrenocortical reserves in valvular surgical patients whose sympathoadrenal system has already been chronically stimulated by a low output state.
The important role of the neuroendocrine system in maintaining homeostasis postoperatively has long been recognized; this relative cortisol deficiency may be aetiologically related to poor postoperative recovery in critically ill valvular surgery patients.
RéSUMé
Les réponses hormonales à l’anesthésie et à la chirurgie ont fait l’objet de la présente étude effectuée chez un groupe de malades soumis à une chirirgie valvulaire ainsi que chez ceux d’un second groupe subissant une chirurgie coronarienne. On a observé une élévation marquée de 1’hormone anti-diurétique secondaire au stress de la chirurgie et cette élévation était semblable chez les patients des deux groupes. Le taux du cortisol s’est également élévé chez les patients des deux groupes en réponse au stress chirurgical, mais cette réponse était atténuée chez les valvulaires, en particulier en fin d’intervention et dans la phase postoperatoire immédiate. Une telle réponse chez les valvulaires peut refiéter l’epuisement des réserves adreno-corticales chez des patients dont le système adreno-sympathique a été stimulé de façon chronique par la présence d’un bas débit cardiaque.
Le rôle important du systéme neuro-endocrinien dans le maintien du l’homoéostase post-opératoire est connu depuis longtemps; la déficience relative en cortisol peut contribuer ç une évolution post-opératoire difficile chez des patients en condition critique.
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Oka, Y., Wakayama, S., Oyama, T. et al. Cortisol and antidiuretic hormone responses to stress in cardiac surgical patients. Canad. Anaesth. Soc. J. 28, 334–338 (1981). https://doi.org/10.1007/BF03007799
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DOI: https://doi.org/10.1007/BF03007799