Cortisol Response to Surgery and Postoperative Confusion in Depressed Patients under General Anesthesia with Fentanyl

Abstract

The purpose of this study was to investigate the relationship between postoperative confusion and plasma cortisol response to surgery in depressed patients. We studied 80 depressed patients and 40 control patients who had undergone orthopedic surgery and perioperatively measured plasma cortisol and adrenocorticotropin levels. Postoperative confusion in the first 3 postoperative days occurred in 5 (13%) depressed patients given fentanyl during anesthesia, 13 (33%) patients without fentanyl and 1 (3%) control patients. Plasma cortisol concentration (19.7 ± 6.9 and 19.2 ± 8.0 µg dl^–1) 15 min after skin incision and 60 min after the end of surgery in depressed patients with fentanyl was significantly lower than that (24.2 ± 7.2 and 23.5 ± 8.1 µg dl^–1) of depressed patients without fentanyl. Plasma cortisol levels during and after surgery in depressed patients with postoperative confusion were higher than those of depressed patients without postoperative confusion. We conclude that the occurrence of postoperative confusion in depressed patients is associated with an increase in plasma cortisol levels during and after surgery. The incidence of postoperative confusion in depressed patients with fentanyl was significantly lower than that of depressed patients without fentanyl.

Influence of Psychiatric Comorbidity on Surgical Mortality

“…It is important to consider our results in the context of the current literature. Several reports [12][13][14][15][16][17][18][19][20][21][27][28][29][30][31][32][33] have examined associations between psychiatric comorbidity and surgical patient outcomes; however, it is difficult to in- fer valid conclusions because of the heterogeneity of the studies regarding the temporal relationship of psychiatric comorbidity identified (eg, psychiatric illness identified before or after surgical admission), type of psychiatric comorbidity studied, and types of outcomes considered.…”

“…For example, in a study of pediatric trauma patients, Gaines et al 32 found that children with a preexisting psychiatric illness had increased ICU and overall hospital-related lengths of stay and were more likely to be discharged to a location other than home. Next, in a further series of studies, Kudoh et al [12][13][14][15][16][17][18][19] examined patients undergoing abdominal and orthopedic surgery and compared a number of outcomes (eg, pain responses to analgesic agents, postoperative psychosis or confusion after anesthesia, and rates of postoperative depression after anesthesia) in cohorts with or without depression or schizophrenia. None of these studies examined mortality as an outcome.…”

“…[8][9][10][11] Associations between psychiatric comorbidity and mortality have largely been limited to patients admitted for the treatment of medical (ie, nonsurgical) conditions [1][2][3][4][5][6][7] ; thus, making valid inferences regarding associations between surgical outcomes and psychiatric comorbidity is limited by the paucity and heterogeneity of available research. For example, studies examining associations between psychiatric comorbidity and surgical mortality are limited to a few studies [12][13][14][15][16][17][18][19][20] of surgical patients with schizophrenia or depression. Studies on a broader range of psychiatric conditions, such as bipolar illness, posttraumatic stress disorder [PTSD], and/or anxiety illness, among surgical patients are nonexistent, to our knowledge.…”

Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration

“…Three reports suggested that patients with schizophrenia have more postoperative complications including death and may present at later stage of surgical disease [6–8]. Two found that pre-operative discontinuation of psychotropic medication in patients with schizophrenia or depression resulted in more postoperative delirium, confusion, and psychiatric symptoms than when medications were continued [9, 10]. The systematic review found no studies of clinical outcomes of surgery for patients with preoperative PTSD or bipolar disorder.…”

Endocrine Response to Surgical Stress and Postoperative Confusion in Depressed Patients with Alcohol Abuse

“…Baseline plasma cortisol concentration in depressed patients is increased [5]. We previously reported that the occurrence of postoperative confusion in depressed patients is associated with increased plasma cortisol concentrations during and after surgery [6]. Thus, plasma cortisol response to surgery appears to play animportant role in the occurrence of postoperative confusion.…”