Inhibition of the cortisol response to surgical stress in chronically depressed patients.
OBJECTIVE
To evaluate whether the pituitary-adrenal and catecholamine response to surgical stress is modified in chronically depressed patients.


METHODS
Prospective, controlled study.


METHODS
25 ASA physical status I and II depressed patients taking chronic antidepressant therapy and 25 control patients undergoing orthopedic surgery of the extremities.


METHODS
All patients received anesthesia induction with thiopental 5 mg/kg and suxamethonium 1 mg/kg intravenously (IV) and were maintained with 1.5% to 2.0% isoflurane in nitrous oxide (70%) and oxygen (30%).


RESULTS
Plasma cortisol concentration (27.7 +/- 3.6 microg/dL) in chronic depressed patients at 60 minutes after the skin incision was not significantly higher than that (23.9 +/- 2.7 microg/dL) before the induction, although plasma cortisol concentration in the control group significantly increased. Plasma norepinephrine concentration at 60 min after the skin incision in depressed patients with more symptoms of depression was significantly higher than that of patients with less symptoms of depression.


CONCLUSIONS
The cortisol response to surgical stress in depressed patients was inhibited and norepinephrine response to surgical stress was increased in depressed patients with more symptoms of depression.
Kudoh
A
A
Department of Anesthesiology, University of Hirosaki School of Medicine, 036, Hirosaki, Japan.
Ishihara
H
H
Matsuki
A
A
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000097:blood; D002908:Chronic Disease; D003863:Depression / Q000097:blood* / Q000523:psychology; D004837:Epinephrine / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010913:Pituitary-Adrenal System / Q000502:physiology; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013312:Stress, Physiological / Q000097:blood*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*
D002395:Catecholamines; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D004837:Epinephrine