title: Osteocalcin and the hormonal, inflammatory and metabolic response to major orthopaedic surgery.
abstract: Plasma osteocalcin, a marker of osteoblastic activity, decreases after major abdominal and gynaecological surgery. Increased cortisol secretion and other hormonal and inflammatory components of the peri-operative stress response may play a role in mediating this response. We assessed the effects of three different anaesthetic techniques on peri-operative osteocalcin concentrations. Thirty-six female patients undergoing elective total hip replacement were randomly assigned to receive propofol, propofol plus 'three-in-one' block or etomidate as part of a general anaesthetic technique. We measured plasma osteocalcin and serum cortisol, bone specific alkaline phosphatase, interleukin-6, plasma epinephrine, norepinephrine, plasma glucose and cystatin C concentrations for up to 3 days after surgery. Etomidate successfully inhibited the cortisol response to surgery but plasma osteocalcin declined in all patients. This was accompanied by increased plasma catecholamines, interleukin-6 and glucose concentrations, and decreased cystatin C-values. Inhibition of the cortisol response to surgery failed to prevent a decrease in plasma osteocalcin concentrations after surgery, suggesting that other factors such as cytokines or catecholamines may play a significant role.
authors.affiliation: Senior Lecturer, Department of Anaesthesia, St George's Hospital Medical School, London SW17 0RE, UK. gnichols@sghms.ac.uk
authors.forename: G
authors.initials: G
authors.lastname: Nicholson
authors.forename: A E
authors.initials: AE
authors.lastname: Bryant
authors.forename: I A
authors.initials: IA
authors.lastname: Macdonald
authors.forename: G M
authors.initials: GM
authors.lastname: Hall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D019644:Arthroplasty, Replacement, Hip; D015415:Biomarkers / Q000097:blood; D005045:Etomidate / Q000494:pharmacology; D005260:Female; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008875:Middle Aged; D009407:Nerve Block; D015675:Osteocalcin / Q000097:blood*; D011184:Postoperative Period; D015742:Propofol / Q000494:pharmacology
chemical_list: D018686:Anesthetics, Intravenous; D015415:Biomarkers; D006728:Hormones; D015675:Osteocalcin; D006854:Hydrocortisone; D015742:Propofol; D005045:Etomidate