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Canadian Journal of Anesthesia, Vol 16, 361-371, Copyright © 1969 by Canadian Anesthesiologists' Society

Hazards of Steroids in Association with Anaesthesia

TSUTOMU OYAMA M.D.1

1 Department of Anaesthesiology, Hirosaki University School of Medicine, Hirosaki, Japan

The present study was undertaken to investigate the correlation between arterial hypotension during anaesthesia or operation and adrenocortical hypofunction in 14 patients previously treated with steroid. None of these patients received steroids on the day before operation or on the day of surgery. A group of ten patients who had no history of receiving steroid therapy and who underwent operations served as a control. Both groups of patients received the same premedication and halothane-N2O anaesthesia.

The mean free cortisol level in the plasma after 30 minutes of halothane-N2O anaesthesia alone (10.8 ± 1.5 µg per 100 ml) in the steroid treated patients did not change from the preinduction value (10.7 ± 1.8 µg per 100 ml), while in the control group it increased significantly from 10.8 ± 1.4 to 17.5 ± 1.4 to 17.5 ± 1.6 µg per 100 ml. Plasma levels of cortisol one hour after the start of operation were insignificantly elevated (14.8 ± 2.5 µg) in the steroid treated patients, but in the control patients they rose significantly to 26.3 ± 1.8 µg.

Arterial hypotension occurred in five steroid treated patients during anaesthesia alone or during operation, and except for one case a low level (0-9 µg) of free cortisol was observed in plasma. However, it was not necessaiy that the timing of hypotension corresponded with the lowest plasma cortisol level. On the contrary, three other patients with low levels of plasma cortisol did not show any arterial hypotension during the procedure. These data would suggest that low plasma free cortisol levels in the peripheral venous blood during anaesthesia or surgery are not necessary to represent arterial hypotension in the steroid treated patients and vice versa.

In order to prevent a possible so-called adrenocortical insufficiency during operation in patients previously treated with steroid, the author suggests that the following patients should receive hormone preoperatively and during operation: (a) patients currently under steroid treatment; (b) patients who have had continuous treatment for more than one month in the six months prior to operation or who have received more than 1 gm of cortisol or equivalent other steroids.






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Copyright © 1969 by the Canadian Anesthesiologists' Society.