Adrenal Function During Long-Term Anesthesia in Man

Abstract

The present studies were designed to elucidate the effect of long-term general anesthesia with endoltracheal nitrous oxide and halothane upon adrenocortical and medullary function in man. Cortisol blood levels are known to increase in man during short-term general anesthesia without surgery ( 1 ) . However, cortisol secretion during long-term general anesthesia without additional surgery has not been studied. Cortisol release from the adrenal cortex is stimulated by pituitary ACTH, which in turn is activated by the hypothalamus via corticotropin releasing factor (CRF) ( 2 ) . An intricate negative feedback regulation between cortisol blood levels and the pituitary and hypothalamic centers keeps this system in balance ( 3 ) . The CRFproducing nerve cells are connected by neuronal synapses with higher brain centers (4). One might, therefore, assume that reduction of neocortical activity during general anesthesia would alter cerebro-hypothalamo-pituitary-adrenal function. However, it is surprising that the reduction in cortical activity of the brain should cause an increase rather than a decrease in cortisol blood levels.The present work suggests that, in fact, a decrease in adrenocortical activity does occur and that the increase previously found may be related to extraneous factors such as excitement during the second stage of anesthesia.Materials and Methods. Twelve healthy unrnedicated male volunteers (age 21 to 30 1 This paper was supported in part by U. S. Public Health Service Grants 1 PO1 GM15571-02 and 5T1 and the Levi J. and Mary Skaggs Foundation. Dr. Von Werder was in part supported by the Deutsche Forschungsgemeinschaft. 2Present address: I1 Klin. Med. Univ. Munich, Munich, Germany.years) were selected for study. In 5 subjects anesthesia was induced with 40 to 80% nitrous oxide (NzO) at approximately 9:30 a.m. After 10 to 15 min. halothane was added. The subjects' tracheae were intubated without the aid of muscle relaxants and the alveolar halothane concentration was adjusted to 0.5% with 70% nitrous oxide. The alveolar halothane was subsequently increased every 15 min to 1 and 1.5%. The subjects were then maintained on 1% alveolar halothane and 70% N20 for 3.5 hr, after which the halothane concentration was varied again in 15-min intervals (0.5, 1, 1.5, and 2%). No other stresses were imposed during the anesthesia. I n the remaining 7 subjects, N20 was omitted and general anesthesia was induced and maintained with halothane alone. After endotracheal intubation, the alveolar halothane concentration was maintained at 1.0 or 1.6%. Five percent glucose was slowly infused after onset of anesthesia to assure a constant blood glucose level during the procedure. In addition, the subjects who received only halothane were challenged with increasing endotracheal COz concentrations before and during the anesthesia to obtain cardiorespiratory CO2 responses. The results of these studies will be reported elsewhere. Of this group, one subject was infused with 1 mg of hydrocortisone succinate/hr anesthesia and the sec...

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From the Journal archives: A harbinger of modern anesthesia

“…Moreover, Oyama's approach could not test the impact of the effect of longer durations of anesthesia without the stimulation provided by surgery. von Werder et al supplied this additional information, 11 supporting and enlarging on Oyama's observations. In this case, von Werder avoided the limitations imposed by the use of patients and studied volunteers.…”