Morbidity in diabetic and non-diabetic patients after major vascular surgery.
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Blood Glucose↗
Biomedical subjects
H Kehlet
Publications and source records attributed to H Kehlet.
Analgesic, respiratory and endocrine responses in normal man to THIP, a GABA-agonist.
In a controlled study, the effects of THIP (a synthetic gamma-aminobutyric-acid-agonist) on respiratory function (ventilatory response to CO2), first detection of stimulation (electrical stimulation of a tooth), pain threshold, magnitude of maximal tolerated pain stimulation, and plasma cortisol, prolactin and glucose were investigated in six normal men. Intramuscular injection of THIP in dosages of both 10 mg and 20 mg increased the magnitude of stimulus before first detection, and the pain threshold as well as the maximal tolerance of pain stimulation. THIP did not lead to changes in respiratory function, or in plasma cortisol, prolactin or glucose, suggesting an analgesic action independent of opiate receptors.
Adult↗
Immediate and long-term mental recovery from general versus epidural anesthesia in elderly patients.
The postoperative course of mental performance during the first week and at 3 months after operation was studied in 30 patients above the age of 60, undergoing total hip replacement arthroplasty. The patients were randomly allocated to receive either general anesthesia, epidural analgesia, or general anesthesia plus epidural analgesia. The surgically induced increase in plasma cortisol and glucose was inhibited in the two groups receiving epidural analgesia. Mental performance was studied with psychological methods. An equal degree of postoperative impairment of mental performance of 3-4 days' duration was found in all groups. Three months after surgery, mental function had improved slightly and to the same extent in all groups. We conclude that the after surgery, mental function had improved slightly and to the same extent in all groups. We conclude that the transient mental impairment occurring within the first postoperative week is caused by factors other than general anesthetic agents and the endocrine-metabolic response to surgery.
Aged↗
Value of the 30-minute adrenocorticotropin (ACTH) test in demonstrating hypothalamic-pituitary-adrenocortical insufficiency after acute ACTH deprivation.
Adrenocortical responsiveness to corticotropin was reestablished by daily administration of 1 mg ACTH depot for 4 days in seven patients with secondary adrenocortical insufficiency. Peak plasma cortisol concentrations during a 30-min ACTH test performed 2 days after stopping injection of ACTH depot increased in all seven subjects (they were normal in five subjects) compared to the initial subnormal responses. Repeated short ACTH tests 5, 8, and 12 days after the last administration of ACTH depot showed a gradual decrease in plasma cortisol responses. When tested 8 days after the last ACTH depot injection was given all seven patients again had a subnormal response to ACTH. Thus, acute ACTH deprivation leads to an impaired adrenocortical response at a short ACTH test within 8-12 days.
Adrenal Cortex↗
Discrepancy between plasma C-peptide and insulin response to oral and intravenous glucose.
Plasma insulin, proinsulin, and C-peptide responses to 25 g glucose orally and intravenously administered were measured in 10 healthy males. Plasma insulin response was higher during the oral load in accordance with the "incretin" concept. However, the actual amount of insulin secreted, as measured by the plasma C-peptide response, was similar during the two glucose loads. The higher plasma insulin response after oral glucose was not due to crossreactivity with proinsulin in the insulin assay. These results suggest that the higher plasma insulin response during an oral glucose load is due at least partially to a lower hepatic extraction of insulin.
Administration, Oral↗
Long-term clinical effects of ovarian wedge resection in polycystic ovarian syndrome.
Twenty-nine consecutive patients with polycystic ovary (PCO) syndrome (defined as hirsutism plus oligomenorrhea or secondary amenorrhea, and excluding Cushing's syndrome, an androgen-secreting adrenal or ovarian tumor or adrenocortical hyperplasia) were treated with ovarian wedge resection leaving normal-sized ovaries. Long-term follow-up from 2.3-9.5 years (mean 5.7 years) showed that 26 of 29 patients (90%) had established normal menstrual cycles. Fertility and normal pregnancies were achieved in all 10 patients (100%) with normal postoperative menstrual cycles who desired to conceive, but not in the 3 patients with remaining postoperative oligomenorrhea. Eight of 9 patients who were obese preoperatively and who had normal postoperative menstrual cycles showed a major weight loss after wedge resection. In contrast, none of the preoperatively obese patients, who remained oligomenorrheic after surgery, lost weight. Hirsutism was not cured by wedge resection. It is concluded that ovarian wedge resection should still be considered useful in patients with PCO.
Amenorrhea↗
[Hypothalamo-hypophyseal adrenal cortical function in chronic alcoholism].
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Adult↗
Fatigue and cardiorespiratory function following abdominal surgery.
Subjective feelings of fatigue were assessed before operation and 10, 20 and 30 days after uncomplicated elective abdominal surgery in 16 otherwise healthy patients, using a constructed fatigue scale model. In addition, all patients had an orthostatic stress test performed at the same times. Six of the patients also underwent a bicycle ergometer test measuring heart rate and oxygen consumption. Subjective feelings of fatigue were increased (P less than 0.01) at all three postoperative observations, and only 5 of 16 patients returned to their preoperative level. The increased subjective feeling of fatigue correlated positively (RS = 0.53, P less than 0.001) with the increased pulse rate seen during orthostatic stress after operation. Heart rate was about 5 per cent higher (n.s.) after operation when bicycling at the same work loads, while oxygen consumption decreased by about 2 per cent (P less than 0.01) at all three postoperative bicycle tests. It is concluded that even electric uncomplicated abdominal surgery is followed by a pronounced feeling of fatigue, which may persist 1 month after surgery in about one-third of patients. The fatigue scale model seems applicable for future studies on the pathogenesis and treatment of the postoperative fatigue syndrome.
Abdomen↗
Influence of extradural morphine on the adrenocortical and hyperglycaemic response to surgery.
Plasma cortisol and glucose concentrations were measured repeatedly from before the induction of anaesthesia until 9 h after skin incision in 36 patients undergoing abdominal hysterectomy. Twelve patients received general anaesthesia (halothane), and systemic opiates for postoperative pain; a further 12 patients underwent continuous extradural analgesia with a local anaesthetic agent (bupivacaine) and in the remaining 12 patients general anaesthesia (halothane) plus extradural morphine (4mg before skin incision and an additional 4mg at skin closure) were used. Patients receiving extradural morphine or bupivacaine were free of pain. The physiological cortisol and glucose response to surgery was blocked by the extradural analgesia with bupivacaine. Extradural morphine did not modify the initial increase in plasma cortisol and glucose concentrations during surgery, but suppressed the hyperglycaemic and cortisol response following surgery when compared with the general anaesthesia group receiving systemic opiates. However, cortisol and glucose concentrations were greater after operation in patients receiving extradural morphine compared with extradural bupivacaine, suggesting that the endocrine metabolic response to surgery is predominantly released by neurogenic stimuli other than pain stimuli involving opiate receptor-dependent nociceptive pathways.
Adult↗
Postoperative glucose tolerance during extradural analgesia.
Thirteen patients undergoing lower abdominal gynaecological surgery were allocated to general anaesthesia (halothane and nitrous oxide) or general anaesthesia plus extradural analgesia (T8-S5). I.v. glucose tolerance tests were performed on the day before surgery and 8 h after skin incision. All patients having extradural analgesia (T8) were pain-free following surgery. Extradural analgesia blocked the hyperglycaemic response to surgery but not the late postoperative cortisol response, although values were significantly less than in the group receiving general anaesthesia alone. Impairment of glucose tolerance and of insulin response to the glucose load in the period after operation were not influenced by extradural analgesia and this may have resulted from insufficient inhibition of the stress-induced release of catecholamines or cortisol, or both, or from blockade of stimulatory efferent sympathetic pathways to pancreatic islets.
Adult↗
Hypothalamic-pituitary-adrenocortical function in chronic alcoholism.
Hypothalamic-pituitary-adrenocortical (HPA) function was assessed during normal daily work and family life in fifteen male brewery workers with a daily alcohol intake of 100 g or more for at least 10 years. Free urinary cortisol was determined during three baseline days and for 3 days during administration of dexamethasone 0.5 mg 6-hourly. All subjects had normal basal urinary cortisol excretion and all except one suppressed normally upon dexamethasone. Four subjects had Cushingoid-like moon face and two of these also had buffalo hump. There was no correlation between free urinary cortisol excretion or dexamethasone suppression and the Cushingoid stigmata. These results suggest that chronic alcohol intake per se does not influence HPA-function.
Adult↗
Effect of posttraumatic epidural analgesia on the cortisol and hyperglycaemic response to surgery.
Plasma cortisol and glucose were measured in 36 patients undergoing abdominal hysterectomy under either general anaesthesia (Group I), epidural analgesia (T4-S5) effective before surgery (Group II) or general anaesthesia plus epidural analgesia (T4-S5) effective from 30 min after initiation of surgery. The results confirmed that epidural analgesia effective before skin incision (Group II) prevented the normal per-and postoperative increase in plasma cortisol and glucose. Patients receiving posttraumatic epidural analgesia (Group III) showed the normal initial increase in plasma cortisol and glucose, but initiation of epidural analgesia immediately broke the stress-response and prevented any further increase in plasma cortisol and glucose. However, although posttraumatic neurogenic blockade inhibited a major part of the stress-response, resting endocrine-metabolic activity was not reestablished, suggesting that once released the endocrine-metabolic response to trauma leads to persistent changes even if further afferent stimuli from the traumatized area are prevented.
Analgesia↗
The endocrine-metabolic response to postoperative pain.
A short review is given on the role of pain as a release mechanism of the endocrine-metabolic response to surgery. It is concluded that: (1) the stress-response is mainly released through afferent neurogenic stimuli from the surgical area; (2) pain may be an additional release mechanism but quantitatively of minor importance compared to other afferent stimuli; (3) neurogenic blockade and analgesia with local anaesthetics prevents a major part of the stress-response to surgery; (4) systemically administered opiates may lessen the postoerative endocrine-metabolic response, but further studies are needed before any definite conclusion can be drawn; and (5) epidural administration of opiates has no major influence on the postoperative stress-responses.
Anesthesia, Epidural↗
Postoperative changes in coagulation and fibrinolysis independent of neurogenic stimuli and adrenal hormones.
Postoperative changes in various haemostatic parameters (capillary bleeding time, platelet count, fibrinogen, fibrinmonomers, prothrombin, antithrombin III, factor VIII procoagulant, factor VIII antigen, euglobulin clot lysis time, streptokinase lysis time, fibrinogen related antigens, alpha 1-antitrypsin and alpha 2-macroglobulin) plasma glucose and cortisol were studied in 12 female patients undergoing elective abdominal hysterectomy during either general anaesthesia or epidural analgesia (T4-S5). General anaesthesia and epidural analgesia (T4-S5). General anaesthesia and epidural analgesia on their own had only negligible influence on haemostatic parameters. Hysterectomy during general anaesthesia caused activation of coagulation and fibrinolysis, followed by depression of fibrinolysis. Epidural analgesia prevented the cortisol and glucose response to surgery, but did not influence the coagulation and fibrinolytic response to surgery, except for an inhibition of the postoperative increase in factor VIII antigen. It is concluded that postoperative changes in the coagulation and fibrinolytic systems are mediated by factors other than neurogenic stimuli and adrenal hormones.
Adult↗
Metabolic response to subtotal thyroidectomy in propranolol-treated thyrotoxic patients.
Changes in plasma cortisol, glucose, cyclic AMP, blood leucocytes, pulse rate and body temperature were measured during and for 24 h after subtotal thyroidectomy in eight propranolol-treated (120-160 mg per day) mild to moderate thyrotoxic patients and eight patients with a non-toxic goitre. The results showed a similar metabolic response to surgery in the two groups without any trends towards a hypermetabolic response in the toxic group. The accumulating evidence of the safety of preoperative preparation with propranolol in patients with mild to moderate thyrotoxicosis is thus supported by our results.
Adult↗
Influence of epidural analgesia on postoperative changes in various serum enzyme patterns and serum bilirubin.
Postoperative changes in serum bilirubin, various serum enzymes (alanine-amino transferase ALAT), alkaline phosphatase (AP), lactate-dehydrogenase (LDH), and creatine-phosphokinase (CPK)), plasma glucose and cortisol were studied in 20 healthy, premenopausal women undergoing elective abdominal hysterectomy under either general anaesthesia with halothane or epidural analgesia (T4-S5). Surgery under general anaesthesia was followed by increased levels of bilirubin, LDH, CPK, glucose and cortisol, whereas AP and ALAT were unaffected by surgery. Epidural analgesia inhibited increases in LDH, CPK, glucose and cortisol (P less than 0.05), but not the increase in bilirubin. The results indicate that afferent neurogenic stimuli from the surgical area are important in mediating the postoperative changes in LDH and CPK, whereas factors other than neurogenic stimuli or adrenal hormones are responsible for the postoperative changes in bilirubin.
Adult↗
Respiratory, analgesic and endocrine responses to an enkephalin analogue in normal man.
In a controlled study, the effect of a new enkephalin analogue (FW 34-569, Sandoz) on respiratory function (ventilatory response to CO2), pain threshold (hot plate technique), and plasma cortisol, prolactin, growth hormone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) was investigated in six normal subjects. One milligram of enkephalin, but not 0.5 mg, resulted in a significantly decreased ventilatory response to CO2, although mean values were not significantly different from saline control values (0.05 less than P less than 0.1). Neither 0.5 mg nor 1.0 mg enkephalin influenced pain threshold, but doses stimulated growth hormones and prolactin release and inhibited the release of cortisol and LH, while FSH remained unchanged.
Adult↗
Effect of fentanyl on the cortisol and hyperglycemic response to abdominal surgery.
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Abdomen↗