Beta-endorphin, cortisol and postoperative delirium: a preliminary report.
A transient delirium, including hallucinations and disorientation, occurred at some time during a 48 to 72 hr postoperative period in patients recovering from elective surgery in an intensive care unit. The occurrence of delirium in these patients was associated with a significant and unusually prolonged postoperative increase in circulating levels of beta-endorphin (B-endorphin) and cortisol, and a total disruption of normal plasma circadian rhythms of B-endorphin and cortisol. Postoperative mean 24-hr plasma levels of B-endorphin and cortisol were not significantly different from preoperative baseline levels in those patients who did not exhibit post-surgical delirium. Circadian rhythms of B-endorphin and cortisol in the non-delirious patients also remained normal following surgery, although peak plasma concentrations were significantly phase-shifted to later in the day. A disruption in circadian rhythms of the endogenous opiate/hypothalamic-pituitary-adrenal axis may represent an important component of post-operative psychological changes that are frequently observed in the intensive care unit setting.
McIntosh
T K
TK
Bush
H L
HL
Yeston
N S
NS
Grasberger
R
R
Palter
M
M
Aun
F
F
Egdahl
R H
RH
D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D003693:Delirium / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D004723:Endorphins / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D001615:beta-Endorphin
D004723:Endorphins; D001615:beta-Endorphin; D006854:Hydrocortisone