The effect of cortisol suppression on interleukin‐6 and white blood cell responses to surgery

Jameson, P. M.; Desborough, J.P.; Bryant, Annie; Hall, George

doi:10.1111/j.1399-6576.1997.tb04683.x

Cited by 47 publications

(31 citation statements)

References 17 publications

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“…Several factors are likely to be involved in mediating the white cell responses to surgery. Physiologic cortisol and catecholamines can influence the distribution of leukocytes 18,19. Unfortunately, we did not monitor hormone levels such as cortisol, prolactin, or catecholamines, or neutrophil function, subtypes of lymphocytes and leukocytes, CRP, interleukin-6, or plasma ketorolac concentration.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Ketorolac on WBC Response and Pain in Laparoscopic Surgery for Endometriosis

Hong

2005

Yonsei Med J

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Surgical stress causes changes in the composition of white blood cells (WBCs). Ketorolac is believed to have analgesic effects and to reduce the stress response and may therefore improve postoperative outcomes. The aim of this study was to assess the effect of preoperative ketorolac on the WBC subsets in patients who had laparoscopic surgery for endometriosis. Fifty patients who had laparoscopic surgery for endometriosis were randomly assigned to one of two groups: the ketorolac group (n = 25) received ketorolac 0.5 mg/kg before the induction of anesthesia, and the control group (n = 25) received saline. White cell count, differential, and pathology studies were done immediately after surgery, on postoperative day 1, and on postoperative day 3. We compared the baseline values within and between the two groups. We also assessed postoperative pain and side effects. The time that elapsed before the first patient request for analgesia, total meperidine dose and VAS (Visual Analog Scale) for postoperative pain were significantly lower in the ketorolac group than in the control group. Compared to the pre- surgical values, there was an increase in total WBC count and percentage of neutrophils, but a decrease in percentages of lymphocytes, monocytes, eosinophils, basophils, and leucocytes. Total WBC count, neutrophils, monocytes, eosinophils and leucocytes showed significant differences between the two groups. The incidences of postoperative side effects, such as nausea, dizziness, headache, and shoulder pain were not different between the groups. Preoperative ketorolac reduced postoperative pain and influenced the WBC response in laparoscopic surgery for endometriosis.

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Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Ketorolac on WBC Response and Pain in Laparoscopic Surgery for Endometriosis

Hong

2005

Yonsei Med J

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“…The ability of glucocorticoids to modulate cytokine production is well known [1] and we have shown recently that etomidate alters interleukin-6 release in routine surgery [10]. Thus, the interpretation of data in which there are concurrent changes in cortisol and cytokine values is difficult [3].…”

Section: Discussionmentioning

confidence: 99%

Fentanyl and the interleukin‐6 response to surgery

1997

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SummaryIt has been suggested that large doses of opioids may suppress the interleukin-6 response to surgery. We examined the effects of the supplementation of inhalational anaesthesia with either 3 or 15 mg.kg ¹1 fentanyl on the circulating interleukin-6, interleukin-8, C-reactive protein, cortisol and glucose concentrations in 16 patients undergoing pelvic surgery. In both groups, surgery evoked the expected glucose, cortisol and interleukin-6 response but no increase in interleukin-8 was detected. There were no significant differences between the two groups. We conclude that the supplementation of inhalational anaesthesia with conventional doses of opioids does not modify the cytokine response to surgery. Cytokines are important mediators of the physiological response to surgical trauma. Interleukin-6 is the major circulating cytokine found after routine surgery and stimulates the acute phase response [1]. Both the size and the duration of the increased interleukin-6 concentration are roughly proportional to the severity of the surgical trauma [2]. There is little information on the effects of anaesthesia on the cytokine changes associated with surgery. Crozier et al. found that interleukin-6 release in response to abdominal surgery was less with a total intravenous technique (propofol and alfentanil) than with an inhalational technique [3]. They postulated that the opioid was responsible for the attenuated response and indicated cellular mechanisms by which this may occur. Nevertheless, an effect of propofol cannot be excluded.The purpose of this study was to compare the effects of supplementing inhalational anaesthesia with either 3 or 15 mg.kg ¹1 fentanyl on the interleukin-6 response to pelvic surgery. We also measured interleukin-8 levels, as these are known to increase in various inflammatory states and with cardiopulmonary bypass [4,5] but the effects of routine surgery are unclear. MethodsWe studied 16 women undergoing total abdominal hysterectomy for nonmalignant disease. They were otherwise healthy and had no endocrine or metabolic disorders. The patients were allocated randomly to receive either 3 or 15 mg.kg ¹1 fentanyl intravenously at induction of anaesthesia. The study was approved by the local ethics committee and written, informed consent was obtained from all patients.Patients were given temazepam 20 mg orally for premedication 90 min before surgery. In the anaesthetic room, a central vein was catheterised via the antecubital fossa for the administration of intravenous fluids and the collection of blood samples. In all patients anaesthesia was induced with thiopentone in a dose sufficient to obtund the eyelash reflex and fentanyl 3 or 15 mg.kg ¹1 given intravenously according to the randomisation. Vecuronium 0.1 mg.kg ¹1 was administered to facilitate tracheal intubation and the patients' lungs were ventilated with isoflurane and 66% nitrous oxide in oxygen. Sodium chloride 0.9% solution was infused at a rate of 6 ml.kg ¹1 .h ¹1 during the operation and 2 ml.kg ¹1 .h ¹1 after surgery. Standar...

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“…Jameson et al (52) showed that compared to thiopentone, etomidate reduced plasma cortisol concentrations and increased plasma IL-6 concentrations in women undergoing hysterectomies. In pediatric patients with meningococcal sepsis, Den Brinker et al (53) showed that plasma IL-6 concentrations were inversely related to the cortisol:ACTH ratios and increased in patients who had received etomidate.…”

Section: Discussionmentioning

confidence: 99%

Differential effects of etomidate and its pyrrole analogue carboetomidate on the adrenocortical and cytokine responses to endotoxemia*

Pejo

Feng²,

Chao³

et al. 2012

Critical Care Medicine

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Objective We developed a novel pyrrole analogue of etomidate, (R)-ethyl 1-(1-phenylethyl)-1H-pyrrole-2-carboxylate (carboetomidate), which retains etomidate’s desirable anesthetic and hemodynamic properties but lacks its potent inhibitory affect on adrenocorticotropic hormone-stimulated steroid synthesis. The objective of this study was to test the hypothesis that in contrast to etomidate, carboetomidate neither suppresses the adrenocortical response to endotoxemia nor enhances the accompanying production of pro-inflammatory cytokines. Design Animal study Setting University research laboratory Subjects Male Sprague-Dawley rats Interventions For both single and multiple anesthetic dose studies, rats were injected with Escherichia coli lipopolysaccharide immediately followed by a hypnotic dose of etomidate, carboetomidate or vehicle alone (dimethyl sulfoxide) as a control. For single dose studies, no additional anesthetic (or vehicle) was administered. For multiple anesthetic dose studies, additional doses of anesthetic (or vehicle) were administered every 15 min for a total of eight anesthetic (or vehicle) doses. Measurements and Main Results Plasma adrenocorticotropic hormone, corticosterone, and cytokine concentrations were measured before lipopolysaccharide administration and intermittently throughout the 5 hour experiment. In single anesthetic dose studies, plasma adrenocorticotropic hormone and cytokine concentrations were not different at any time point among the etomidate, carboetomidate, and vehicle groups whereas plasma corticosterone concentrations were briefly (60–120 min) reduced in the etomidate group. In multiple anesthetic dose studies, plasma corticosterone concentrations were persistently lower and peak plasma IL-1β and IL-6 concentrations were higher in the etomidate group versus the carboetomidate and control groups. Peak plasma IL-10 concentrations were similarly elevated in the etomidate and carboetomidate groups versus the control group. Conclusions Compared to etomidate, carboetomidate produces less suppression of adrenocortical function and smaller increases in pro-inflammatory cytokine production in an endotoxemia model of sepsis. These findings suggest that carboetomidate could be a useful alternative to etomidate for maintaining anesthesia for a prolonged period of time in patients with sepsis.

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The effect of cortisol suppression on interleukin‐6 and white blood cell responses to surgery

Abstract: In conclusion, endogenous corticosteroids modulate the interleukin-6 response to surgery.

Cited by 47 publications

References 17 publications

The Effect of Preoperative Ketorolac on WBC Response and Pain in Laparoscopic Surgery for Endometriosis

The Effect of Preoperative Ketorolac on WBC Response and Pain in Laparoscopic Surgery for Endometriosis

Fentanyl and the interleukin‐6 response to surgery

Differential effects of etomidate and its pyrrole analogue carboetomidate on the adrenocortical and cytokine responses to endotoxemia*

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