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Catecholamine and cortisol responses to lower extremity revascularization: correlation with outcome variables. Perioperative Ischemia Randomized Anesthesia Trial Study Group. Crit Care Med 1995 Dec;23(12):1954-61

Date

12/01/1995

Pubmed ID

7497717

DOI

10.1097/00003246-199512000-00003

Scopus ID

2-s2.0-9044227624   103 Citations

Abstract

OBJECTIVE: To determine whether catecholamine and cortisol secretory responses to surgery contribute to postoperative complications.

DESIGN: Prospective, randomized, case series.

SETTING: A university hospital operating suite and surgical intensive care unit.

PATIENTS: Sixty patients undergoing lower extremity vascular surgery.

INTERVENTIONS: Patients were randomized to receive either epidural anesthesia/epidural opiate analgesia (regional anesthesia) or general anesthesia/intravenous patient-controlled analgesia (general anesthesia).

MEASUREMENTS AND MAIN RESULTS: Anesthesia was managed according to a prospectively designed protocol. Hemodynamic parameters and plasma catecholamine concentrations were determined at specific intraoperative and postoperative time points. Intraoperative and postoperative urine samples were collected and analyzed for free cortisol concentrations. Outcomes evaluated were cardiac (nonfatal myocardial infarction and cardiac death) and surgical (graft occlusion). Mean arterial pressure during emergence from anesthesia and in the early postoperative period correlated positively with plasma norepinephrine concentration (p < .01). In addition, plasma catecholamine concentrations were higher in patients with postoperative hypertension. Plasma norepinephrine concentrations at the time of emergence from anesthesia and postoperatively were also higher in patients requiring repeat surgery for graft revision, thrombectomy, or amputation (p < .05). Multivariate analysis indicated that the norepinephrine concentration at the time of emergence, but not type of anesthesia, correlated with reoperation for graft occlusion, suggesting that the previously reported beneficial effect of regional anesthesia may be due to modulation of the stress response. Myocardial infarction or cardiac death occurred in three patients. These patients had markedly increased catecholamine concentrations.

CONCLUSIONS: The catecholamine response to lower extremity vascular surgery contributes to the development of postoperative hypertension and may also be important in the development of thrombotic complications.

Author List

Parker SD, Breslow MJ, Frank SM, Rosenfeld BA, Norris EJ, Christopherson R, Rock P, Gottlieb SO, Raff H, Perler BA

Author

Hershel Raff PhD Professor in the Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Analgesia, Patient-Controlled
Anesthesia, Conduction
Anesthesia, Epidural
Anesthesia, General
Blood Pressure
Catecholamines
Humans
Hydrocortisone
Hypertension
Leg
Middle Aged
Multivariate Analysis
Norepinephrine
Postoperative Complications
Reoperation
Stress, Physiological
Thrombosis
Treatment Outcome
Vascular Surgical Procedures
jenkins-FCD Prod-484 8aa07fc50b7f6d102f3dda2f4c7056ff84294d1d