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Canadian Journal of Anesthesia, Vol 15, 441-457, Copyright © 1968 by Canadian Anesthesiologists' Society

Effect of Halothane and Methoxyflurane Anaesthesia on Plasma Cortisol Concentration In Relation to Major Surgery

KATSURO NISHIOKA M.D., PH.D., ASHLEY A. LEVY PH.D., and ALLEN B. DOBKIN M.D.

Serial assays of plasma cortisol concentrations were carried out before, during, and after major surgical procedures in 68 patients, employing halothane and methoxyflurane as the primary anaesthetic agents. A simple fluorimetric assay procedure was used which provided accurate data rapidly.

Synacthen® (synthetic {beta} 1-24 corticotropin) was employed in place of natural ACTH as a chemical stimulus of the adrenal cortex and was found to be an effective and safe test of the patients' response to stress. No immunological reactions occurred with this preparation.

Atropine and meperidine premedication did not affect the response to the test. The initial rise in the plasma cortisol levels after induction of anaesthesia was slower than that produced by the injection of {beta} 1-24 corticotropin, probably due to the administration of thiopentone during induction of anaesthesia.

The plasma cortisol levels rose to quite high levels during surgical operations with methoxyflurane anaesthesia when synthetic {beta} 1-24 corticotropin was administered, whereas they were somewhat depressed when halothane anaesthesia was employed. However, there was no striking difference between the two anaesthetics and surgery when no {beta} 1-24 corticotropin was given.

The significance of the plasma cortisol level with respect to circulatory homeostasis is not known, but an adequate level appears to be essential during induction of anaesthesia and the performance of major surgery.

Elderly patients had the same general response on the plasma cortisol level during anaesthesia and surgery as younger patients, and there were no apparent differences due to the sex of the patient provided adrenocortical insufficiency was not present.

This test may be particularly useful in patients who have received steroid therapy in the past, in order to determine whether they require supportive therapy during an operation.

Note:

From the Department of Anesthesiology, State University Hospital, State University of New York, Upstate Medical Center, Syracuse, New York.






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Copyright © 1968 by the Canadian Anesthesiologists' Society.