Non-neurological surgery results in a neurochemical stress response.

• There is a paucity of studies assessing changes in measures of human neurotransmission during stressful events, such as surgery. Thirty-five patients without any neurological disorders undergoing knee replacements with spinal bupivacaine anaesthesia and propofol sedation had cerebrospinal fluid (CSF) drawn from a spinal catheter before, three hours after and the morning after surgery. The CSF concentrations of the dopamine metabolite homovanillinic acid (HVA) and the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), which are related to the activity of the dopaminergic and serotonergic systems of the brain, increased sharply during surgery and reached 188% and 166% of their initial concentrations on the morning after the intervention (p < 0.0001). The CSF concentrations of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglucol (MHPG) increased modestly (non-significantly) during and after surgery. The HVA/5-HIAA ratios initially increased but returned to the initial level during the night after surgery. We conclude that non-neurological surgery, in this case to the lower limb, is accompanied by a marked central nervous stress response in spite of a spinal blockade.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

Keyword

Aged

Aged

80 and over

Anesthesia

Spinal

Arthroplasty

Replacement

Knee

psychology

Chromatography

High Pressure Liquid

Female

Homovanillic Acid

cerebrospinal fluid

Humans

Hydroxyindoleacetic Acid

cerebrospinal fluid

Male

Methoxyhydroxyphenylglycol

cerebrospinal fluid

Middle Aged

Stress

cerebrospinal fluid

physiopathology

stress

propofol

spinal anaesthesia

Catecholamines

serotonin

Publication and Content Type

ref (subject category)

art (subject category)