High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy

Watanabe, Kôji; Kashiwagi, Kunitomo; Kamiyama, Tomonari; Yamamoto, Makiko; Fukunaga, Masaki; Inada, Eiichi; Kamiyama, Yoichiro

doi:10.1007/s00540-013-1738-x

Cited by 34 publications

(30 citation statements)

References 20 publications

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“…When the body suffered sudden intense stimulation, both ACTH and COR levels were significantly increased because of stress reaction. Watanabe et al [30] also demonstrated that plasma concentrations of ACTH and COR were both increased during capnoperitoneum. We speculate that the reasons may be: (1) increased intra-abdominal pressure resulted in reduced renal perfusion and then activated the vascular control center of the medulla oblongata, which enhanced sympathetic activation; (2) pain caused by surgical trauma activated the hypothalamus-adenohypophysis-adrenocortical system, which induced elevated ACTH and COR.…”

Section: Discussionmentioning

confidence: 99%

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

Niu

Song²,

Su³

et al. 2017

Medicine

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Background: We aimed to evaluate the effect of different capnoperitoneum pressures on stress responses in pediatric laparoscopic inguinal hernia repair.Methods: In this prospective randomized controlled study, 68 children with indirect inguinal hernia who underwent high ligation of hernia sac were randomly divided into 3 groups: high-pressure group (12 mm Hg, HP group, n = 26); low-pressure group (8 mm Hg, LP group, n = 20); open operation group (OP group, n = 22). Heart rate (HR), blood pressure, and end-tidal CO 2 (PetCO 2 ) were recorded, as well as the levels of adrenocorticotropic hormone (ACTH) and cortisol (COR) were measured by ELISAs before operation, during operation, and after operation, respectively.Results: After establishing capnoperitoneum, HR, blood pressure, and PetCO 2 were significantly increased in the HP group compared with the OP and LP groups (P < 0.05). Comparing the intraoperatively measured ACTH and COR concentrations of the HP group to the LP group, we noted higher values in the first (P < 0.05). There was no significant difference in the postoperative concentrations of ACTH and COR among the HP, LP, and OP groups. Abbreviations: ACTH = adrenocorticotropic hormone, ASA = American Society of Anesthesiologists, COR = cortisol, DBP = diastolic blood pressure, ELISA = enzyme-linked immuno sorbent assay, HP = high-pressure, HR = heart rate, LP = low-pressure, OP = open operation, PetCO 2 = end-tidal CO 2 , SBP = systolic blood pressure, SD = standard deviation.

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Section: Discussionmentioning

confidence: 99%

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

Niu

Song²,

Su³

et al. 2017

Medicine

View full text Add to dashboard Cite

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“…Previous studies have shown that anaesthetic drugs, more specifically the hypnotic etomidate, can suppress adrenocortical synthesis of cortisol . However, many other drugs may have HPA suppressive properties as suggested by small interventional studies in surgical and ICU patients, by observational studies of surgical patients and by animal experiments. Based on the available evidence, we hypothesized that the pharmacological effects of drugs used during surgery or the acute phase of critical illness prior to ICU admission may explain the acute ‘ACTH‐cortisol dissociation’, as observed upon admission to the ICU.…”

Section: Introductionmentioning

confidence: 97%

Drug-induced HPA axis alterations during acute critical illness: a multivariable association study

et al. 2016

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“…A second limitation is that one cannot exclude additional suppression at the hypothalamic level from analgo-sedative drugs that are used throughout ICU stay, of which opioids are the main component [37]. Indeed, intra-operative opioids and prolonged opioid use for chronic pain have shown to lower plasma ACTH concentrations [38–42]. Furthermore, in healthy subjects, morphine blunts the ACTH response to CRH injection at a supra-pituitary level [43].…”

Section: Discussionmentioning

confidence: 99%

ACTH and cortisol responses to CRH in acute, subacute, and prolonged critical illness: a randomized, double-blind, placebo-controlled, crossover cohort study

et al. 2018

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PurposeLow plasma ACTH in critically ill patients may be explained by shock/inflammation-induced hypothalamus-pituitary damage or by feedback inhibition exerted by elevated plasma free cortisol. One can expect augmented/prolonged ACTH-responses to CRH injection with hypothalamic damage, immediately suppressed responses with pituitary damage, and delayed decreased responses in prolonged critical illness with feedback inhibition.MethodsThis randomized, double-blind, placebo-controlled crossover cohort study, compared ACTH responses to 100 µg IV CRH and placebo in 3 cohorts of 40 matched patients in the acute (ICU-day 3–6), subacute (ICU-day 7–16) or prolonged phase (ICU-day 17–28) of critical illness, with 20 demographically matched healthy subjects. CRH or placebo was injected in random order on two consecutive days. Blood was sampled repeatedly over 135 min and AUC responses to placebo were subtracted from those to CRH.ResultsPatients had normal mean ± SEM plasma ACTH concentrations (25.5 ± 1.6 versus 24.8 ± 3.6 pg/ml in healthy subjects, P = 0.54) but elevated free cortisol concentrations (3.11 ± 0.27 versus 0.58 ± 0.05 µg/dl in healthy subjects, P < 0.0001). The order of the CRH/placebo injections did not affect the ACTH responses, hence results were pooled. Patients in the acute phase of illness had normal mean ± SEM ACTH responses (5149 ± 848 pg/mL min versus 4120 ± 688 pg/mL min in healthy subjects; P = 0.77), whereas those in the subacute (2333 ± 387 pg/mL min, P = 0.01) and prolonged phases (2441 ± 685 pg/mL min, P = 0.001) were low, irrespective of sepsis/septic shock or risk of death.ConclusionsSuppressed ACTH responses to CRH in the more prolonged phases, but not acute phase, of critical illness are compatible with feedback inhibition exerted by elevated free cortisol, rather than by cellular damage to hypothalamus and/or pituitary.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5427-y) contains supplementary material, which is available to authorized users.

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High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy

Cited by 34 publications

References 20 publications

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

Low-pressure capnoperitoneum reduces stress responses during pediatric laparoscopic high ligation of indirect inguinal hernia sac

Drug-induced HPA axis alterations during acute critical illness: a multivariable association study

ACTH and cortisol responses to CRH in acute, subacute, and prolonged critical illness: a randomized, double-blind, placebo-controlled, crossover cohort study

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