[Stress and the endocrine system. A contribution to the value of endocrine parameters in anesthesia and surgery]

This study examined prospectively the effects of different anaesthetic techniques on the plasma concentrations of adrenocorticotrophic hormone (ACTH), aldosterone, cortisol, dehydroepiandrosterone (17-DHEA), insulin, prolactin, thyroxine, triiodothyronine as well as the effects on the plasma concentrations of epinephrine, norepinephrine and dopamine. Forty patients for trauma surgery were randomly allocated to one of the following anaesthetic techniques: halothane-N2O/O2-anaesthesia, isoflurane-N2O/O2-anaesthesia, midazolam-fentanyl-N2O/O2-anaesthesia, midazolam-ketamine-N2O/O2-anaesthesia or tramadol-N2O/O2-anaesthesia. The results of this endocrinological study demonstrate differences in the quality of the anaesthetic techniques used even without extreme stress situations for the patient. The elimination of pain can reduce, but not avoid, endocrinologic response to stress. Endocrine values are influenced by a lot of different control mechanisms. It is not always possible to distinguish between pharmacologic and indirect or direct effects of anaesthesia or surgery. For this reason, single plasma hormone levels should not be overvalued and equated with "stress" indicators, which is a much more complicated issue.