• Ann Fr Anesth Reanim · Apr 2014

    Review

    [Interaction between hypnotic agents and the hypothalamic-pituitary-adrenocorticotropic axis during surgery.]

    • E Besnier, T Clavier, H Castel, P Gandolfo, F Morin, M-C Tonon, C Marguerite, B Veber, B Dureuil, and V Compère.
    • Département d'anesthésie-réanimation chirurgicale - SAMU, CHU de Rouen, 1, rue de Germont, 76031 Rouen, France; Inserm U982, DC2N Laboratory of Neuronal and Neuroendocrine Cell Differentiation and Communication, Astrocyte and Vascular Niche, IRIB, University of Rouen, PRES Normandy, 76821 Mont-Saint-Aignan, France.
    • Ann Fr Anesth Reanim. 2014 Apr 1;33(4):256-65.

    AbstractDuring stress, the relationship between the central nervous system and the immune system is essential to maintain homeostasis. The main neuroendocrine system involved in this interaction is the hypothalamic-pituitary-adrenal axis (HPA), which via the synthesis of glucocorticoids will modulate the intensity of the inflammatory response. Anaesthetic agents could be interacting with the HPA axis during surgery. Although etomidate currently remains in the center of the discussions, it seems, at least experimentally, that most hypnotics have the capacity to modulate the synthesis of adrenal steroids. Nevertheless, with the large literature on this subject, etomidate seems to be the most deleterious hypnotic agent on the HPA axis function. Its use should be limited when HPA axis is already altered.Copyright © 2014. Published by Elsevier SAS.

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