Perioperative response of leptin and the tumor necrosis factor alpha system in morbidly obese patients. Influence of cortisol inhibition by etomidate

• Published in: Acta anaesthesiologica Scandinavica Vol. 45; no. 2; pp. 207 - 212
• Main Authors: Montalbán, C., Del Moral, I., García-Unzueta, M. T., Villanueva, M. A., Amado, J. A.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01.02.2001; Blackwell
• Subjects: Adrenocorticotropic Hormone - blood; Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous - pharmacology; Biological and medical sciences; cortisol; etomidate; Etomidate - pharmacology; Female; Gastroplasty; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Hydrocortisone - antagonists & inhibitors; Hydrocortisone - blood; Laparotomy; Leptin; Leptin - blood; Medical sciences; Middle Aged; Obesity, Morbid - blood; Receptors, Leptin; Receptors, Tumor Necrosis Factor - metabolism; thiopentone; Time Factors; TNFα; Tumor Necrosis Factor-alpha - metabolism; Human; Corticosteroid; Imidazole derivatives; Obesity; Thiopental sodium; Nutrition disorder; Cytokine; General anesthesia; Hydrocortisone; Etomidate; General anesthetic; Surgery; Leptin; Barbiturates; Nutritional status; Tumor necrosis factor α
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2001.450212.x

Background: Leptin, tumor necrosis factor alpha (TNFα) and soluble TNFα receptors are secreted by the adipose tissue. Surgery induces a complex cytokine and neurohormonal response. The aim of our study was to investigate the perioperative response of leptin and the TNFα system in morbidly obese patients submitted to gastroplasty, and the possible involvement of cortisol in their responses. Methods: Serum cortisol, adrenocorticotropic hormone (ACTH), leptin, TNFα and soluble TNFα receptor I were measured in 22 morbidly obese women (11 anesthetized with thiopental and 11 with etomidate, a well known inhibitor of cortisol synthesis). Samples were collected before anesthesia induction, just before surgical incision, and 2, 4, 6, 12, 24 and 48 h after the start of surgery. Results: Baseline serum leptin correlated with body mass index (r=0.567, P=0.007). Baseline serum leptin and TNFα were higher than normal. Cortisol release was inhibited in the etomidate group with a subsequent higher stimulation of ACTH release. A statistically significant decrease in serum leptin levels was observed in both groups at 2, 4, 6 and 48 h, compared with basal values. A similar decrease in serum TNFα levels was observed in both groups, but the decrease reached significance only in the etomidate group. Serum soluble TNFα receptor I did not decrease. No differences were found between the two groups in leptin, TNFα or soluble TNFα receptor I concentrations at any time. Conclusion: Serum leptin and TNFα levels decrease in obese patients during gastroplasty. Transitory inhibition of cortisol release does not alter this response.