Influence of Perioperative Factors on the Level of Cortisol in Anesthesia During Cardiac Surgery

Abstract

Background. In this study the dependence of the level of cortisol on the age of the patient, the presence of disorders of fat metabolism, the dose of muscle relaxant and anesthetic propofol was revealed. Determining the level of cortisol as a component of anesthetic monitoring enables not only to assess the level of perioperative stress, but also to predict the height of the expected stress response. The aim of our study was to determine the influence of perioperative factors on cortisol levels during cardiac surgery. Material and methods. A prospective non-randomized observational study was conducted. The study involved 30 cardiac surgery patients. The age of the patients ranged from 49 to 67 (64 (59; 70)) years, the body mass index was 29.05 (25.56; 33.25) kg/m2. All the patients underwent cardiac surgery under cardiopulmonary bypass. All the patients underwent venous blood sampling to determine the level of cortisol at the following stages: stage 1 - the patient on the operating table, peripheral vein catheterization; Stage 2 - during anesthesia, before connecting to a heart-lung machine; Stage 3 - the end of the operation, suturing the skin; Stage 4 - 1-3 hours after the operation; Stage 5 - 17-20 hours after surgery. Quantitative determination of cortisol in blood serum was carried out by the immunochemical method using the Architect plus i10000sr apparatus (Abbott, USA). Results. The analysis of the obtained data showed that the level of cortisol in the early postoperative period was significantly higher in patients older than 65 (18.8 (10.3; 26.0) µg/dL). The level of cortisol at the second stage of the study was higher in patients with impaired fat metabolism (11.1 (7.1; 15.6) µg/dL). Cortisol levels were significantly lower with higher doses of pipecuronium bromide during anesthesia (5.8 (3.6; 10.5) µg/dL). A significant correlation was found between the dose of propofol at the induction stage and the level of cortisol at stage 4 (R=-0.6; р=0.007). A moderate inverse correlation was established between the level of cortisol and the total dose of fentanyl at the second stage (R=-0.43; p=0.017). Conclusion. Determining the level of cortisol should be a component of anesthetic monitoring when performing cardiac surgery under conditions of cardiopulmonary bypass.

Endocrine and metabolic monitoring for anesthesia care in orthopedic trauma surgery on the lower extremities of children: prospective comparative study

“…В настоящее время стандартный анестезиологический мониторинг во время оперативного вмешательства включает показатели контроля гемодинамики, оксигенации, вентиляции, минимальной альвеолярной концентрации (МАК) ингаляционного анестетика, температуры тела и других параметров, однако лишь косвенно позволяет оценить достижение эффективного уровня аналгезии, достаточного для защиты пациента от хирургической травмы [6]. В последнее десятилетие появились публикации, анализирующие показатели кортизола, глюкозы, лактата, интерлейкина-6 во время анестезиологического обеспечения травматичных оперативных вмешательств в абдоминальной хирургии, онкологии, кардиохирургии, урологии у взрослых и детей [7][8][9]. Имеются лишь единичные исследования, в которых изучены показатели кортизола, глюкозы и лактата при ортопедо-травматологических операциях на нижних конечностях у детей [10,11].…”