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Adrenal function following coronary bypass surgery.

M Weiskopf, G D Braunstein, T M Bateman

    American Heart Journal
    |July 1, 1985
    PubMed
    Summary
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    Intraoperative steroid administration during coronary bypass surgery significantly lowers postoperative cortisol levels. Adrenocortical function remains normal despite hypothermia and bypass, but steroids blunt the stress response.

    Area of Science:

    • Endocrinology
    • Cardiovascular Surgery

    Background:

    • Adrenocortical function following coronary bypass surgery (CBS) with hypothermia and cardiopulmonary bypass (CPB) is not well understood, especially with intraoperative steroid use.
    • The impact of CPB and hypothermia on adrenal hormones requires further investigation.

    Purpose of the Study:

    • To investigate adrenocortical function after CBS under hypothermic CPB.
    • To assess the effect of intraoperative methylprednisolone administration on postoperative cortisol levels and adrenal responsiveness.

    Main Methods:

    • Pilot study involving eight patients receiving intravenous methylprednisolone during CBS, with pre- and postoperative serum cortisol measurements.
    • A separate study in seven patients assessed serum cortisol and aldosterone levels and their response to adrenocorticotropic hormone (ACTH) before and after CBS, without intraoperative steroids.

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    Main Results:

    • Patients receiving methylprednisolone showed significantly lower 18-hour postoperative cortisol levels compared to preoperative levels.
    • In patients without intraoperative steroids, postoperative cortisol and aldosterone levels increased significantly, indicating a normal adrenal stress response.
    • Adrenal responsiveness to ACTH remained normal throughout the perioperative period, including post-hypothermia and post-CPB.

    Conclusions:

    • Coronary bypass surgery with hypothermic CPB does not impair basal adrenocortical function or ACTH responsiveness.
    • Intraoperative methylprednisolone administration blunts the normal adrenal stress response to bypass surgery for at least 18 hours postoperatively.
    • Normal adrenal responsiveness occurs after coronary bypass surgery despite hypothermia, CPB, and anesthesia effects.