The rapid low-dose (1 μg) cosyntropin test in the immediate postoperative period: Results in elderly subjects after major abdominal surgery

Richards, Melanie L.; Caplan, Robert H.; Wickus, Gary G.; Lambert, Pamela J.; Kisken, William A.

doi:10.1016/s0039-6060(99)70011-5

Cited by 45 publications

(27 citation statements)

References 42 publications

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“…In this context, major surgery can serve as a standardized model for studying critical illness per se, although, of course, the underlying neuroimmunoendocrine adaptation is more complex in patients with septic shock. Proposed lower thresholds for peak basal cortisol levels in the immediate peri-and postoperative period range from 500 nmol/liter (18 g/dl) to 693 nmol/liter (25 g/dl) (14,16,20,25,26), which compares well with the thresholds in critically ill patients (14, 16, 20 -23).…”

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confidence: 55%

“…Patients with an alleged relative adrenal insufficiency demonstrate elevated basal cortisol levels that are still considered inadequate for the markedly increased glucocorticoid demands of severe stress (14,16,18). Unfortunately, the proposed lower thresholds for stresselevated basal cortisol concentrations vary widely in the literature; they range from 416 nmol/liter (15 g/liter) to 693 nmol/liter (25 g/dl) and even more than 935 nmol/liter (34 g/dl), depending on the degree and chronicity of the critical illness (14, 16, 20 -24) and surgical stress (14,16,20,25,26). Furthermore, an inadequate rise in cortisol after ACTH stimulation of less than 250 nmol/liter (Ͻ9 g/dl) was suggested to mirror less responsive suprarenal glands or a limited adrenal reserve in septic patients, respectively (14,16,19,(27)(28)(29).…”

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confidence: 99%

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Cortisol Response in Relation to the Severity of Stress and Illness

Widmer

Puder

König

et al. 2005

The Journal of Clinical Endocrinology & Metabolism

203

169

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confidence: 55%

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confidence: 99%

Cortisol Response in Relation to the Severity of Stress and Illness

Widmer

Puder

König

et al. 2005

The Journal of Clinical Endocrinology & Metabolism

203

169

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show abstract

“…In our studies, the effective inhibitory dose of dexamethasone on StAR mRNA expression was at 10 ng/ml (1.94 9 10 -8 M) which is less than circulating levels of cortisol found in humans under stress, such as hypotension and sepsis, and following trauma or surgery (250 ng/ ml) [26][27][28][29]. Since, greater than 90% of circulating glucocorticoids are bound by transcortin [30,31], the dose (10 ng/ml) of dexamethasone, a more potent synthetic glucocorticoid, may represent an overestimate of the amount of free glucocorticoid circulating in the blood of these stressed men, and the effect seen is probably more pharmacological than physiological.…”

Section: Discussionmentioning

confidence: 54%

Dexamethasone-induced suppression of steroidogenic acute regulatory protein gene expression in mouse Y-1 adrenocortical cells is associated with reduced histone H3 acetylation

Fon

2007

Endocr

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In this study, we investigated the effect of dexamethasone on the expression of steroidogenic acute regulatory protein (StAR) and the acetylation of histone H3 in mouse Y-1 adrenocortical tumor cells. Treatment of Y-1 cells with increasing concentrations (0.001-50 microg/ml) of dexamethasone for 24 h suppressed 8-Br-cAMP (0.5 mM)-stimulated StAR mRNA and protein levels and progesterone production in a dose-dependent manner. Treatment of Y-1 cells with 8-Br-cAMP (0.5 mM) for 1-24 h resulted in a marked increase in StAR mRNA levels. This increase was associated with an increase in progesterone production. StAR mRNA was down-regulated by dexamethasone at times greater than 3 h. To evaluate dexamethasone effect on the endogenous StAR gene, chromatin immunoprecipitation assays were performed in combination with polymerase chain reaction. 8-Br-cAMP increased histone H3 acetylation within the proximal region of the StAR gene promoter and coincubation with dexamethasone blocked this effect. Dexamethasone had no effect on glucocorticoid receptor mRNA expression. These results demonstrate that dexamethasone repression of 8-Br-cAMP-stimulated StAR gene expression in Y-1 cells is accompanied by reductions in histone H3 acetylation associated with the StAR gene promoter.

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“…Oral steroids, such as prednisone, have also been used in the treatment of back pain, with little substantial benefit [28,29]. Patients who have taken oral steroids for a prolonged period of time may be at risk for adrenal insufficiency, which is more than twice as common in the elderly [30]. The need for intraoperative supplementation and postoperative steroid taper is derived from the duration of steroid use prior to the procedure, and the invasiveness of the planned surgery [31].…”

Section: Opioid Analgesicsmentioning

confidence: 99%

The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

Brallier

Deiner

2015

Drugs Aging

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Spine surgery is one of the most common surgeries for adults greater than 65 years of age. Optimizing and caring for the elderly patient presenting for spine surgery requires planning and multidisciplinary input from surgeons, primary care physicians, and anesthesiologists. Controversies exist surrounding appropriate perioperative management of complicated chronic medication regimens and the ideal selection of intraoperative therapy for these patients. In this article we present an overview of the controversies anesthesiologists face as they work with the elderly patient's primary doctor and surgical team to achieve a safe perioperative course. Specifically, we discuss the interaction of geriatric physiology and pathophysiology with medications used in the perioperative period. While care of the geriatric spine surgery patient is nuanced, the anesthesiologist can work together with medical personnel, surgeons, and pharmacy to provide safe and effective care. Key PointsSpine surgery is one of the five most common surgeries for older adults.Optimizing and caring for the elderly patient presenting for spine surgery requires planning and multidisciplinary input from surgeons, primary care physicians, and anesthesiologists.Controversies exist surrounding appropriate perioperative management of complicated medication regimens and the ideal manner in which to care for these patients.Continuation of chronic medications, selection of intraoperative medications, and plan for postoperative pain control are strongly influenced by the surgical plan.

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The rapid low-dose (1 μg) cosyntropin test in the immediate postoperative period: Results in elderly subjects after major abdominal surgery

Cited by 45 publications

References 42 publications

Cortisol Response in Relation to the Severity of Stress and Illness

Cortisol Response in Relation to the Severity of Stress and Illness

Dexamethasone-induced suppression of steroidogenic acute regulatory protein gene expression in mouse Y-1 adrenocortical cells is associated with reduced histone H3 acetylation

The Elderly Spine Surgery Patient: Pre- and Intraoperative Management of Drug Therapy

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