Canadian Journal of Anesthesia, Vol 26, 186-190, Copyright © 1979 by Canadian Anesthesiologists' Society

Adrenocortical Response to General Anaesthesia and Surgery

¹ Hirosaki University Medical School, Hirosaki, Aomori-ken, Japan

The effects of stimulation by synthetic ACTH (beta 1-24 corticotrophin) on the adrenocortical response, judged from plasma levels of cortisol, were studied during general anaesthesia and surgery in 55 adult patients. Fifty patients had not been treated with glucocorticoid, another five patients had hypoadrenocortical function due to the glucocorticoid treatment. ACTH 0.25 mgwas administered intramuscularly immediately before the induction of anaesthesia. Plasma levels of cortisol 30 minutes after the induction with various different anaesthetics were increased about 80 per cent in patients who had not been treated with glucocorticoids. The plasma concentrations of cortisol remained elevated until the patient had recovered from anaesthesia in the recovery room.

No appreciable increase in the plasma cortisol was observed in the glucocorticoid-treated patients. These patients had been considered to have reduced adrenal function as judged by the results of the rapid ACTH test, carried out one week before operation. These results suggest that in patients who have not been treated with glucocorticoids the adrenocortical response to exogeneous ACTH during general anaesthesia and surgery is well preserved, and is increased when compared to surgical subjects who have not been stimulated with ACTH. However, in the glucocorticoid-treated patients, adrenocortical response was reduced as judged from the plasma cortisol concentration after stimulation by ACTH administration during general anaesthesia and surgery. Therefore, the preoperative evaluation of adrenocortical function should be emphasized in glucocorticoid-treated patients and in patients in whom adrenocortical hypofunction is suspected.