Increased cortisol response to surgery in patients with alcohol problems who developed postoperative confusion.

Background: Patients with alcohol problems often develop postoperative confusion and have impaired cortisol, ACTH, and norepinephrine. However, the relationship between neuroendocrine responses to surgical stress and postoperative confusion remains unclear in patients with alcohol problems.

Methods: Plasma cortisol, ACTH, and norepinephrine concentrations during and after surgery in 30 patients with alcohol problems and 30 control patients who underwent lower abdominal surgery were measured before the induction of anesthesia, 15 and 60 min after skin incision, 60 min after the end of surgery, the next day, and the second day after the operation.

Results: Plasma cortisol concentrations (21.2 +/- 4.7 microg x dl) of patients with alcohol problems before anesthesia were significantly higher than 15.6 +/- 4.8 microg x dl(-1) of control patients. Plasma cortisol and ACTH responses to surgery in patients with alcohol problems were not significantly increased compared with preoperative values. The incidence of postoperative confusion was significantly higher in patients with alcohol problems than that of control patients (33% vs. 3%). Plasma cortisol concentrations (29.7 +/- 7.0, 31.2 +/- 6.6, 30.3 +/- 8.0, and 28.4 +/- 6.2 microg x dl(-1)) 15 and 60 min after the skin incision, 60 min after the end of surgery, and the next day after operation in postoperatively confused patients with alcohol problems were significantly higher than those of nonconfused patients with alcohol problems (23.0 +/- 5.8, 22.7 +/- 4.1, 22.4 +/- 7.2, and 21.9 +/- 5.5 microg x dl(-1)).

Conclusion: The cortisol response to surgical stress increases in patients with alcohol problems who develop postoperative confusion, although cortisol response to surgical stress decreases in patients with alcohol problems without postoperative confusion.