Adrenocortical Activity in the Preoperative Period

IN a previous paper it was reported that in the preoperative period the plasma levels of adrenocortical steroids in some patients were remarkably high (1). The eosinophil count has also been shown to diminish with the approach of surgery (2). This evidence of increased activity of the adrenal cortex is difficult to explain, since there was no treatment in the preoperative period. However, it is well known that patients who are going to be operated upon are more or less under psychic tension which may increase as the day of operation draws near, suggesting that the preoperative increase of adrenocortical activity may be due to emotional stimuli. This paper is concerned with the level of plasma corticosteroids in patients during the preoperative period. The plasma levels of the same patients one and two days earlier were used as controls. Thirty-three patients in the surgical department of the Karolinska Hospital were selected at random. The average age was 56 years (range, 26 to 75 years). Eighteen were men and 15 were women. All endocrine cases were excluded. The patients were informed about the time of the operation at least one day in advance. The first blood sample was taken two days preoperatively, the second sample one day before, and the third the morning of the operation. The blood samples were taken between 7 and 8 A.M.