Biomedical subjects
Publications and source records attributed to H Kehlet.
Urinary excretion of 17-ketosteroids was measured during dexamethasone substitution followed by ACTH (Synacthen Depot, 1 mg daily) in 10 non-virilized adrenalectomized women. No significant changes could be demonstrated indicating ovarian androgenic dependence of ACTH in non-virilized females.
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Forty-eight patients receiving glucocorticoid treatment were tested with ACTH stimulation using alpha(1, 24) ACTH (tetracosactrin). All patients subsequently underwent non-acute major surgery without any glucocorticoid administration, and their clinical course and plasma corticosteroids were followed closely. No case of adrenocortical insufficiency was observed. A highly significant correlation was found between the pre-operative adrenocortical response to ACTH and the hypothalmic-pituitary-adrenocortical (H.P.A.) response to surgery. A normal response to ACTH stimulation was never followed by a greatly impaired H.P.A. response to surgery. It seems that a simple ACTH stimulation test is reliable in predicting the integrated H.P.A. response to major stress in glucocorticoid-treated patients.
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Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree of surgical expertise and use of other perioperative therapeutic interventions including nutrition and mobilization, should be combined to improve overall perioperative care and surgical outcome.