Response to surgical stress in elderly patients and Alzheimer's disease.
OBJECTIVE
To determine the effect of surgical stress on plasma epinephrine, norepinephrine, ACTH and cortisol concentrations in patients aged 80-99 yr and in patients complicated with Alzheimer's disease.


METHODS
A prospective controlled study was undertaken in 55 undergoing surgical reduction of femur neck fracture in Hirosaki University hospital and Hakodate Watanabe hospital; 18 patients in 80-99 yr (Group 1) and 18 patients in 40-59 yr (Group 2) and 7 patients (Group A) with and 12 patients (Group B) without Alzheimer's dementia (AD) aged 60-79 yr.


RESULTS
The increase in plasma norepinephrine level (274%) of group 1 patients, 15 min after skin incision was higher than that in group 2 (191%) (P < 0.01). Mean plasma cortisol levels (40.4+/-4.7 and 44.1+/-5.2 microg x dl(-1)) of group 1, 15 min after skin incision and 60 min after the end of surgery were significantly higher than the 29.8+/-3.5 and 22.3+/-3.0 microg x dl(-1) of group 2 (P < 0.05). Plasma norepinephrine (1092.9+/-112.0 pg x ml(-1)) and cortisol concentrations (53.4+/-5.8 microg x dl(-1)) in group A were higher than in group B (772.6+/-82.4 pg x ml(-1) and 41.7+/-4.3 microg x dl(-1)) 15 min after skin incision (P < 0.05).


CONCLUSIONS
Plasma norepinephrine and cortisol responses to surgical stress are activated in elderly patients and in patients with Alzheimer's disease.
Kudoh
A
A
Division of Anesthesia, Hakodate Watanabe Hospital, Japan.
Ishihara
H
H
Matsuki
A
A
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000097:blood*; D004837:Epinephrine / Q000097:blood; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011446:Prospective Studies; D013312:Stress, Physiological / Q000097:blood*
D006728:Hormones; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine