Endocrine response to surgical stress in three patients over 100 yr

Abstract

Purpose: To report the change of plasma epinephrine, norepinephrine, cortisol, plasma renin activity, plasma aldosterone and plasma atrial natriuretic peptide during general anesthesia in three centenarian patients. Clinical features: Three patients aged 101, 101 and 102-yr, underwent a screw fixation of femoral fracture under general anesthesia. Plasma concentrations of epinephrine, norepinephrine, cortisol, renin activity, aldosterone and atrial natriuretic peptide were measured before the induction of anesthesia, 15 min after incision and 60 min after the end of surgery. Plasma epinephrine concentrations in the three patients increased from 419, 344 and 377 pg·ml-1 before anesthesia to 688, 534 and 478 pg·ml-1 15 min after skin incision. Plasma norepinephrine concentrations increased markedly from 408, 513 and 606 pg·ml-1 before anesthesia to 2950, 1864 and 1574 pg·ml-1 15 min after skin incision. The cortisol response to surgery was similar to that of young adults. Plasma aldosterone and renin activity was low throughout anesthesia. Plasma atrial natriuretic peptide increased from 353, 367 and 109 pg·ml-1 before induction to 479, 487 and 168 pg·ml-1 15 min after skin incision. Conclusion: Plasma norepinephrine concentration in patients over 100 yr increased markedly during anesthesia, while plasma renin activity and aldosterone were lower.