Key result
Higher doses of propofol at induction and fentanyl during anesthesia were significantly inversely correlated with postoperative cortisol levels (R=-0.6, p=0.007 and R=-0.43, p=0.017, respectively).
Why the study?
Cortisol monitoring enables assessment of perioperative stress and prediction of the stress response, but the influence of perioperative factors during cardiac surgery required evaluation.
Observational (n=30)
Perioperative factors such as age, fat metabolism, and anesthetic doses significantly influence cortisol levels during cardiac surgery, suggesting its utility in anesthetic monitoring.
Propofol/fentanyl doses were associated with lower cortisol; hypothesis-generating for stress-response monitoring, should not change practice.
Background. In this study the dependence of the level of cortisol on the age of the patient, the presence of disorders of fat metabolism, the dose of muscle relaxant and anesthetic propofol was revealed. Determining the level of cortisol as a component of anesthetic monitoring enables not only to assess the level of perioperative stress, but also to predict the height of the expected stress response. The aim of our study was to determine the influence of perioperative factors on cortisol levels during cardiac surgery. Material and methods. A prospective non-randomized observational study was conducted. The study involved 30 cardiac surgery patients. The age of the patients ranged from 49 to 67 (64 (59; 70)) years, the body mass index was 29.05 (25.56; 33.25) kg/m2. All the patients underwent cardiac surgery under cardiopulmonary bypass. All the patients underwent venous blood sampling to determine the level of cortisol at the following stages: stage 1 - the patient on the operating table, peripheral vein catheterization; Stage 2 - during anesthesia, before connecting to a heart-lung machine; Stage 3 - the end of the operation, suturing the skin; Stage 4 - 1-3 hours after the operation; Stage 5 - 17-20 hours after surgery. Quantitative determination of cortisol in blood serum was carried out by the immunochemical method using the Architect plus i10000sr apparatus (Abbott, USA). Results. The analysis of the obtained data showed that the level of cortisol in the early postoperative period was significantly higher in patients older than 65 (18.8 (10.3; 26.0) µg/dL). The level of cortisol at the second stage of the study was higher in patients with impaired fat metabolism (11.1 (7.1; 15.6) µg/dL). Cortisol levels were significantly lower with higher doses of pipecuronium bromide during anesthesia (5.8 (3.6; 10.5) µg/dL). A significant correlation was found between the dose of propofol at the induction stage and the level of cortisol at stage 4 (R=-0.6; р=0.007). A moderate inverse correlation was established between the level of cortisol and the total dose of fentanyl at the second stage (R=-0.43; p=0.017). Conclusion. Determining the level of cortisol should be a component of anesthetic monitoring when performing cardiac surgery under conditions of cardiopulmonary bypass.
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Dudko et al. (2022) conducted an observational in Cardiac surgery (n=30). Perioperative factors (propofol, fentanyl, pipecuronium bromide) was evaluated on Cortisol levels at various perioperative stages. Higher doses of propofol at induction and fentanyl during anesthesia were significantly inversely correlated with postoperative cortisol levels (R=-0.6, p=0.007 and R=-0.43, p=0.017, respectively).
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