THE EFFECT OF CORTISOL SUPPRESSION ON INTERLEUKIN-6 AND WHITE BLOOD-CELL RESPONSES TO SURGERY

Background: The endocrine and immune changes associated with surgery a re well documented, but the interaction between them has not been full y evaluated. Cortisol production during surgery can be suppressed by e tomidate and we have used this to investigate the relationship between the cortisol response and immune changes in the perioperative period. Methods: We have measured the cortisol, interleukin-6 and white cell responses to elective abdominal hysterectomy in 8 healthy female patie nts, who received etomidate 0.3 mg kg(-1) for induction of anaesthesia . A control group of 8 subjects received thiopentone. Both groups of p atients received vecuronium and fentanyl 2 mu g kg(-1) and anaesthesia was maintained with nitrous oxide in oxygen and isoflurane 0.5-1.0%. Venous blood samples were collected before and during surgery and up t o 24 h in the postoperative period. Results: Serum interleukin-6 value s were significantly greater at 6 and 12 h (P<0.05) in those patients who received etomidate. inhibition of the serum cortisol response to s urgery in the etomidate group was also associated with less marked lym phopenia at 4 h (P<0.05). There was no significant difference in neutr ophil granulocyte counts between the two groups. Conclusion: In conclu sion, endogenous corticosteroids modulate the interleukin-6 response t o surgery. (C) Acta Anaesthesiologica Scandinavica 41 (1997).