The plasma ACTH, AVP, CRH and catecholamine responses to conventional and laparoscopic cholecystectomy

摘要: Summary OBJECTIVES We compared the responses of stress hormones, Cortisol, ACTH, vasopressin (AVP), corticotrophin releasing hormone (CRH) and catecholamines to elective conventional laparoscopic cholecystectomy. DESIGN A right upper quadrant transverse incision was used for cholecystectomy, four 1–2-cm incisions procedure (for insertion surgical instruments, diathermy, fibreoptic telescope light source, carbon dioxide insufflation). Blood sampled immediately prior premedication (temazepam), after induction anaesthesia (fentanyl thiopentone) at 10-minute intervals until end (N2O maintenance, vecuronium relaxation). blood sample taken reversal, then 50 minutes. Plasma sodium pressure were measured similar intervals. Results are expressed as mean ± standard error. PATIENTS Twelve patients studied (six in each group). MEASUREMENTS Peptide hormones by radioimmunoassay, Cortisol ELISA HPLC. RESULTS The values procedures did not increase significantly anaesthesia. Within 10 minutes first incision, however, there a marked concordant rise plasma ACTH AVP levels both (conventional: from value 2 1 7 80 14 3 pmol/l, 0 4 117 24 P<0 01 hormones; laparoscopic: 5 8 26 551 260 6 11 49 27 09 pmol/l). At types operation still elevated, although ACTH: ratio had increased. Greater variability seen than procedure, three showing relatively small response surgery. Total secretion during surgery different but total less (P<0 05), 01) For procedures, timing peaks related (P< 002). significant CRH observed 30 start P <005). unrelated. maximum level (1268 147 nmol/l) reached 20 reversal remained this sampling. comparable beginning fall 60 post-operatively. adrenaline two different, noradrenaline indicated area increased 02). sodium, renin activity initial systolic procedures. CONCLUSIONS peak is likely be dependent, these related. Subsequent may result an interaction between CRH. Laparoscopic cholecystectomy results smaller does falls more rapidly During period observation, CRH, lessened approach, response. Stress monitoring assist further improvements technique.