title: The hormonal and inflammatory responses to pelvic reconstructive surgery following major trauma.
abstract: Patients undergoing trauma sustain an initial injury followed by further physiological challenges during surgery. Plasma osteocalcin (OC), a marker of osteoblastic activity, declines after major surgery. Increased cortisol secretion, and other components of the perioperative stress response, may play a role in mediating this response. We have examined the osteocalcin, hormonal and cytokine responses in twenty patients undergoing post-traumatic pelvic reconstruction surgery. We measured plasma osteocalcin, serum cortisol, bone specific alkaline phosphatase (BSAP), IL-6, IL-8, IL-10, plasma epinephrine and norepinephrine concentrations for up to 3 days after surgery. We recorded an increase in IL-6, IL-10 and epinephrine concentrations perioperatively and a fall in OC and BSAP concentrations. There were no significant changes in cortisol or IL-8 concentrations. Patients undergoing pelvic reconstruction surgery following trauma have a preserved inflammatory and catecholamine response but the cortisol response may be obtunded. Osteocalcin concentrations are affected by factors other than glucocorticoids.
authors.affiliation: 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: J
authors.initials: J
authors.lastname: Woodfine
authors.forename: A E
authors.initials: AE
authors.lastname: Bryant
authors.forename: I A
authors.initials: IA
authors.lastname: Macdonald
authors.forename: M D
authors.initials: MD
authors.lastname: Bircher
authors.forename: R M
authors.initials: RM
authors.lastname: Grounds
authors.forename: G M
authors.initials: GM
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D005592:Fracture Fixation; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D018836:Inflammation Mediators / Q000097:blood*; D007378:Interleukins / Q000097:blood; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D015675:Osteocalcin / Q000097:blood; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D011184:Postoperative Period; D011446:Prospective Studies
chemical_list: D006728:Hormones; D018836:Inflammation Mediators; D007378:Interleukins; D015675:Osteocalcin; D000469:Alkaline Phosphatase; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine