Stress hormone responses to major intra-abdominal surgery during and immediately after sevoflurane-nitrous oxide anaesthesia in elderly patients.

We studied the responses of plasma epinephrine, norepinephrine, adrenocorticotropic hormone (ACTH), cortisol, and antidiuretic hormone (ADH) during and immediately after sevoflurane-nitrous oxide anaesthesia supplemented with vecuronium in seven elderly patients (mean 76.6 +/- 1.7 SEM) who underwent major intra-abdominal surgery. The plasma concentrations of norepinephrine, ACTH, cortisol, and ADH increased in response to surgical procedures (P < 0.05). The plasma concentration of ADH increased to a peak concentration of 189.1 +/- 20.7 pg.ml-1 30 min after skin incision (P < 0.05). The plasma concentrations of epinephrine, norepinephrine, ACTH, and cortisol increased to peak concentrations of 408.6 +/- 135.5 pg.ml-1, 635.7 +/- 167.8 pg.ml-1, 222.6 +/- 48.0 pg.ml-1, and 113.6 +/- 67.5 micrograms.dl-1, respectively immediately after tracheal extubation (P < 0.05). We conclude that, in the elderly patients, the responses of stress hormones to major intra-abdominal surgery were preserved during sevoflurane-nitrous oxide anaesthesia sufficient to prevent increases in arterial pressure and heart rate. The strongest responses of epinephrine, norepinephrine, ACTH, and cortisol were elicited immediately after tracheal extubation.