Br.J. Anaesth. (1976), 48, 805
BLOOD FIBRINOLYTIC ACTIVITY DURING MAJOR SURGERY IN UNSUPPLEMENTED GLUCOCORTICOID-TREATED PATIENTS A. ENGQUIST SUMMARY
The role of ACTH and corticosteroids in the stressinduced activation of endogenous fibrinolysis is undetermined. Engquist and Winther (1972) reported a significant correlation between fibrinolysis and plasma cortisol concentration in patients with normal hypothalamo-pituitary-adrenal function during major surgical procedures. To investigate further the possible influence of the secretion of endogenous cortisol on the activation of fibrinolysis, blood was analysed for fibrinolytic activity and plasma cortisol concentration in glucocorticoid-treated patients after withdrawal of the glucocorticoids during major surgical stress. PATIENTS AND METHODS
Fifteen patients who were receiving continuous treatment with glucocorticoids were studied. Informed consent was obtained from all patients. Table I summarizes the age, sex, daily dose of prednisone (or equivalent), duration of treatment, diseases requiring glucocorticoid treatment and operation. Glucocorticoid treatment was discontinued 12-24 h before operation. The surgical procedures started between 8.30 and 11.30 a.m. and they were all elective. Anaesthesia was induced with thiopentone i.v. after premedication either with an opiate or phenobarbitone combined with atropine. Neuroleptanalgesic techniques were used and the patients were ventilated with a 2 : 1 nitrous oxide in oxygen mixture. Cyclopropane was used in two patients (3 and 15) and diethyl ether in one patient (2). Pancuronium bromide or tuboA. ENGQUIST, Departments of Anaesthesia, Glostxup and Gentofte Hospitals, Copenhagen, Denmark. Address for correspondence: Department of Anaesthesia II, Gentofte Hospital, 2100 Hellerup, Denmark. 66
curarine were administered to produce muscle relaxation. Arterial pressure and heart rate were recorded every 5th min during anaesthesia and at regular intervals after operation. The sampling of blood and the measurements of blood fibrinolytic activity and plasma cortisol concentration were performed as described by Engquist, Askgaard and Funding (1976). Wilcoxon's rank sum test was used for statistical analysis. P
BLOOD FIBRINOLYTIC ACTIVITY DURING MAJOR SURGERY IN UNSUPPLEMENTED GLUCOCORTICOID-TREATED PATIENTS A. ENGQUIST SUMMARY
The role of ACTH and corticosteroids in the stressinduced activation of endogenous fibrinolysis is undetermined. Engquist and Winther (1972) reported a significant correlation between fibrinolysis and plasma cortisol concentration in patients with normal hypothalamo-pituitary-adrenal function during major surgical procedures. To investigate further the possible influence of the secretion of endogenous cortisol on the activation of fibrinolysis, blood was analysed for fibrinolytic activity and plasma cortisol concentration in glucocorticoid-treated patients after withdrawal of the glucocorticoids during major surgical stress. PATIENTS AND METHODS
Fifteen patients who were receiving continuous treatment with glucocorticoids were studied. Informed consent was obtained from all patients. Table I summarizes the age, sex, daily dose of prednisone (or equivalent), duration of treatment, diseases requiring glucocorticoid treatment and operation. Glucocorticoid treatment was discontinued 12-24 h before operation. The surgical procedures started between 8.30 and 11.30 a.m. and they were all elective. Anaesthesia was induced with thiopentone i.v. after premedication either with an opiate or phenobarbitone combined with atropine. Neuroleptanalgesic techniques were used and the patients were ventilated with a 2 : 1 nitrous oxide in oxygen mixture. Cyclopropane was used in two patients (3 and 15) and diethyl ether in one patient (2). Pancuronium bromide or tuboA. ENGQUIST, Departments of Anaesthesia, Glostxup and Gentofte Hospitals, Copenhagen, Denmark. Address for correspondence: Department of Anaesthesia II, Gentofte Hospital, 2100 Hellerup, Denmark. 66
curarine were administered to produce muscle relaxation. Arterial pressure and heart rate were recorded every 5th min during anaesthesia and at regular intervals after operation. The sampling of blood and the measurements of blood fibrinolytic activity and plasma cortisol concentration were performed as described by Engquist, Askgaard and Funding (1976). Wilcoxon's rank sum test was used for statistical analysis. P
