title: Etomidate and the osteocalcin response to gynaecological surgery.
abstract: Circulating osteocalcin is a good marker of osteoblastic activity and decreases significantly after stressful physiological states such as major surgery. Glucocorticoids are known to inhibit osteoblastic activity and result in a decline in circulating osteocalcin. We used etomidate to inhibit the cortisol response to routine gynaecological surgery to determine if this would prevent the postoperative decline in osteocalcin. Twenty-four patients were allocated randomly to receive either thiopental or etomidate for induction of anaesthesia; all other aspects of anaesthesia and perioperative management were standardized. In the thiopental group, circulating cortisol increased significantly at 2 and 6 h after the start of surgery and plasma osteocalcin concentrations decreased significantly to almost 50% of baseline values at 48 h. Etomidate abolished the cortisol response to surgery, and circulating osteocalcin concentrations did not change after operation. There was a significant difference in osteocalcin concentration between the groups at 48 h. We conclude that the cortisol response to surgery is associated with a postoperative decrease in circulating osteocalcin.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, St George's Hospital Medical School, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: O'Leary
authors.forename: Y
authors.initials: Y
authors.lastname: Lam
authors.forename: A E
authors.initials: AE
authors.lastname: Bryant
authors.forename: J M
authors.initials: JM
authors.lastname: Burrin
authors.forename: G M
authors.initials: GM
authors.lastname: Hall
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D005045:Etomidate / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007044:Hysterectomy; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood*; D011184:Postoperative Period; D013874:Thiopental / Q000494:pharmacology
chemical_list: D018686:Anesthetics, Intravenous; D015675:Osteocalcin; D013874:Thiopental; D006854:Hydrocortisone; D005045:Etomidate