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[Perioperative endothelin, ACTH and cortisol plasma concentrations in coronary bypass patients]
J Hähnel1, D Mutschler, W Huhn
1Universitätsklinik für Anästhesiologie, Ulm.
Insights
This study investigated endothelin (ET), adrenocorticotropic hormone (ACTH), and cortisol levels during heart bypass surgery (CABG). Pulmonary circulation significantly clears ET before surgery, a clearance that is temporarily lost but restored post-operation.
Area of Science:
- Cardiovascular Science
- Endocrinology
- Pulmonary Circulation Physiology
Background:
- Endothelin (ET) plays a crucial role in cardiovascular regulation.
- The hypothalamic-pituitary-adrenal (HPA) axis, involving ACTH and cortisol, is vital for stress response.
- Understanding the interplay between ET and the HPA axis in the context of cardiac surgery is important.
Purpose of the Study:
- To monitor endothelin (ET), adrenocorticotropic hormone (ACTH), and cortisol levels in patients undergoing aortocoronary bypass grafting (CABG).
- To ascertain the extraction of these hormones from plasma by the pulmonary circulation during and after CABG.
Main Methods:
- A convenience sample of eight male patients undergoing routine CABG was studied.
- Hormone levels (ET, ACTH, cortisol) were measured using radioimmunoassay (RIA) techniques.
- Blood samples were collected from pulmonary and radial arteries at multiple time points, from anesthesia induction to 22 hours post-operation.
Main Results:
- A significant correlation was observed between ET and cortisol levels in pulmonary arterial samples (P=0.032).
- Pulmonary circulation significantly extracted ET after anesthesia induction (P=0.042), with this difference diminishing intraoperatively.
- ET extraction by the pulmonary circulation was restored by 22 hours post-operation, albeit at an elevated level.
Conclusions:
- No direct interrelation between ET and the HPA axis was established based on plasma levels.
- The correlation between perioperative ET and cortisol supports the hypothesis of cortisol-induced ET release from vascular smooth muscle cells.
- A net pulmonary clearance of ET occurs pre-CABG, is lost intra- and postoperatively, and tends to recover by the first postoperative day.
Study Objective:
To follow up endothelin (ET), adrenocorticotropic hormone (ACTH), and cortisol levels in patients undergoing aortocoronary bypass grafting (CABG) and to determine whether these are extracted from plasma by the pulmonary circulation.
Design:
Convenience sample trial.
Setting:
University hospital.
Patients:
Eight male routine CABG patients without appreciable concomitant disease.
Interventions:
Patients were given anaesthesia in a strictly standardised manner using etomidate, flunitrazepam, fentanyl, and pancuronium. Nitroglycerin was administered prior to cardiopulmonary bypass (CPB) at 2 mg/h and dopamine as the only catecholamine starting from CPB weaning until the end of sampling at 3.5-5 micrograms/kg.min. Samples were drawn in rapid sequence from cannulated radial and a distal pulmonary arteries (Swan-Ganz catheter) at eight sampling times starting after induction of anaesthesia and catheter placement and finishing 22 h after the end of operation.
Measurements And Results:
ET levels were determined by an ET-1, 2, 3-sensitive radioimmunoassay (RIA), ACTH and cortisol by commercially available RIA kits. There was significant (P = 0.032, linear regression analysis) correlation between ET and cortisol from pulmonary arterial samples. ET was significantly (P = 0.042, two-tailed Wilcoxon test) extracted by the pulmonary circulation after induction of anaesthesia. This pulmonary-systemic arterial difference nearly disappeared intraoperatively, but tended to be restored 22 h after the end of operation at an approximately twofold increased level.
Conclusions:
No interrelation between ET and the hypothalamic-pituitary-adrenal axis could be established by the ET, ACTH, and cortisol plasma levels. However, the significant correlation between perioperative ET and cortisol lends further support to the hypothesis of ET release by cortisol from vascular smooth-muscle cells. There is a net pulmonary clearance of ET in patients prior to CABG that is lost intra- and early postoperatively, but tends to be restored on the 1st day thereafter at an increased level.
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