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Strandby RB, Secher NH, Ambrus R, Gøtze JP, Henriksen A, Kitchen CC, Achiam MP, Svendsen LB. Mid‐regional plasma pro‐atrial natriuretic peptide and stroke volume responsiveness for detecting deviations in central blood volume following major abdominal surgery. Acta Anaesthesiol Scand 2022; 66:1061-1069. [PMID: 36069352 PMCID: PMC9543860 DOI: 10.1111/aas.14126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/10/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022]
Abstract
Background A reduced central blood volume is reflected by a decrease in mid‐regional plasma pro‐atrial natriuretic peptide (MR‐proANP), a stable precursor of ANP, and a volume deficit may also be assessed by the stroke volume (SV) response to head‐down tilt (HDT). We determined plasma MR‐proANP during major abdominal procedures and evaluated whether the patients were volume responsive by the end of the surgery, taking the fluid balance and the crystalloid/colloid ratio into account. Methods Patients undergoing pancreatic (n = 25), liver (n = 25), or gastroesophageal (n = 38) surgery were included prospectively. Plasma MR‐proANP was determined before and after surgery, and the fluid response was assessed by the SV response to 10° HDT after the procedure. The fluid strategy was based mainly on lactated Ringer's solution for gastroesophageal procedures, while for pancreas and liver surgery, more human albumin 5% was administered. Results Plasma MR‐proANP decreased for patients undergoing gastroesophageal surgery (−9% [95% CI −3.2 to −15.3], p = .004) and 10 patients were fluid responsive by the end of surgery (∆SV > 10% during HDT) with an administered crystalloid/colloid ratio of 3.3 (fluid balance +1389 ± 452 ml). Furthermore, plasma MR‐proANP and fluid balance were correlated (r = .352 [95% CI 0.031–0.674], p < .001). In contrast, plasma MR‐proANP did not change significantly during pancreatic and liver surgery during which the crystalloid/colloid ratio was 1.0 (fluid balance +385 ± 478 ml) and 1.9 (fluid balance +513 ± 381 ml), respectively. For these patients, there was no correlation between plasma MR‐proANP and fluid balance, and no patient was fluid responsive. Conclusion Plasma MR‐proANP was reduced in fluid responsive patients by the end of surgery for the patients for whom the fluid strategy was based on more lactated Ringer's solution than human albumin 5%.
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Affiliation(s)
- Rune B. Strandby
- Department of Surgery and Transplantation, Rigshospitalet Institute for Clinical Medicine, University of Copenhagen, Inge Lehmanns Vej 7 Copenhagen Denmark
| | - Niels H. Secher
- Department of Anesthesia, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
| | - Rikard Ambrus
- Department of Surgery and Transplantation, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
| | - Jens P. Gøtze
- Department of Clinical Biochemistry, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
| | - Amalie Henriksen
- Department of Surgery and Transplantation, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
| | - Carl C. Kitchen
- Department of Anesthesia, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
| | - Michael P. Achiam
- Department of Surgery and Transplantation, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
| | - Lars B. Svendsen
- Department of Surgery and Transplantation, Rigshospitalet, Institute for Clinical Medicine University of Copenhagen Denmark
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Sejersen C, Bjerre-Bastos JJ, Goetze JP, Nielsen HB, Bihlet AR, Secher NH. Effect of adrenaline on serum mid-regional pro-atrial natriuretic peptide and central blood volume. Exp Physiol 2022; 107:1037-1045. [PMID: 35912634 PMCID: PMC9545049 DOI: 10.1113/ep090516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022]
Abstract
New Findings What is the central question in this study? Atrial natriuretic peptide (ANP) is secreted in response to atrial wall distension and thus allows for evaluation, albeit indirect, of the central blood volume. Adrenaline has chronotropic and inotropic effects. We evaluated whether the chronotropic and inotropic effects of adrenaline were reflected in mid‐regional proANP. What is the main finding and its importance? Central blood volume remained stable with infusion of adrenaline and yet mid‐regional proANP increased. Thus, the chronotropic and inotropic state of the heart or adrenaline directly induces release of ANP variants from the myocytes.
Abstract Atrial natriuretic peptide (ANP) has vasodilatory, natriuretic and diuretic properties. It is secreted in response to atrial wall distension and thereby provides an indirect evaluation of central blood volume (CBV). Adrenaline has chronotropic and inotropic effects that increase cardiac output. In the present study, we evaluated whether these effects were influenced by an increase in CBV and reflected in mid‐regional proANP (MR‐proANP) concentrations in the circulation, a stable proxy marker of bioactive ANP. Changes in CBV were evaluated by thoracic electrical admittance and haemodynamic variables monitored by pulse‐contour analysis during two intervals with graded infusion of adrenaline. Adrenaline infusion increased heart rate (by 33 ± 18%) and stroke volume (by 6 ± 13%), hence cardiac output (by 42 ± 23%; all P < 0.05). The increase in cardiac output did not result from an increase in CBV, because thoracic electrical admittance remained stable (−3 ± 17%; P = 0.230). Serum MR‐proANP concentrations were increased (by 26 ± 25%; P < 0.001) by adrenaline infusion and remained elevated 60 min postinfusion. We conclude that MR‐proANP in the circulation is affected not only by CBV, but also by increased chronotropy/inotropy of the heart, or that adrenaline directly induces release of ANP variants from the myocytes.
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Affiliation(s)
- Casper Sejersen
- Department of Anaesthesia, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Denmark
| | - Jonathan J Bjerre-Bastos
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,NBCD A/S, Herlev, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Institute for Clinical Medicine.,Department of Biomedical Sciences, Faculty of Health, University of Copenhagen, Denmark
| | - Henning B Nielsen
- Department of Anaesthesia, Zealand University Hospital Roskilde, Institute for Clinical Medicine, University of Copenhagen, Denmark.,Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Denmark
| | | | - Niels H Secher
- Department of Anaesthesia, Rigshospitalet, Institute for Clinical Medicine, University of Copenhagen, Denmark
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Strandby RB, Ambrus R, Achiam MP, Henriksen A, Goetze JP, Secher NH, Svendsen LB. Effect of hypotensive hypovolemia and thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume in pigs: a blinded, randomized controlled trial. Local Reg Anesth 2019; 12:47-55. [PMID: 31417302 PMCID: PMC6599965 DOI: 10.2147/lra.s204594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/16/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose Changes in plasma pro-atrial natriuretic peptide (proANP) may indicate deviations in the central blood volume (CBV). We evaluated the plasma proANP response to hypotensive hypovolemia under the influence of thoracic epidural anesthesia (TEA) in pigs. We hypothesized that plasma proANP would decrease in response to hypotensive hypovolemia and that TEA would aggravate the proANP response, reflecting a further decrease in CBV. Design Randomized, blinded, controlled trial. Setting A university-affiliated experimental facility. Participants Twenty pigs randomized to administration of saline (placebo) or bupivacaine with morphine (TEA) in the epidural space at Th8-Th10. Interventions Relative hypovolemia was established by an inflatable Foley catheter positioned in the inferior caval vein just below the heart (caval obstruction), and hemorrhage-induced hypovolemia was by withdrawal of blood from the femoral artery, both aiming at a mean arterial pressure (MAP) of 50–60 mmHg. Hemodynamic variables and plasma proANP were determined before and after the interventions. Results Caval obstruction and withdrawal of blood reduced MAP to 50–60 mmHg. Accordingly, cardiac output, central venous pressure, and mixed venous oxygen saturation decreased (p<0.05). Yet, plasma proANP was stable after both caval obstruction (TEA: 72 [63–78] to 80 pmol/L [72–85], p=0.09 and placebo: 64 [58–76] to 69 pmol/L [57–81], p=0.06) and withdrawal of blood (TEA: 74 [73–83] to 79 pmol/L [77–87], p=0.07 and placebo: 64 [56–77] to 67 pmol/L [58–78], p=0.15). Conclusion Plasma proANP was stable in response to relative and hemorrhage-induced hypovolemia to a MAP of 50–60 mmHg, and the response was independent of TEA. The findings suggest that alterations in plasma proANP do not follow deviations in CBV during hypotensive hypovolemia in pigs.
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Affiliation(s)
| | | | | | | | | | - Niels H Secher
- Department of Anesthesiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Strandby RB, Ambrus R, Achiam MP, Goetze JP, Secher NH, Svendsen LB. Effect of early versus delayed activation of thoracic epidural anesthesia on plasma pro-atrial natriuretic peptide to indicate deviations in central blood volume during esophagectomy. Reg Anesth Pain Med 2019; 44:rapm-2019-100508. [PMID: 31129617 DOI: 10.1136/rapm-2019-100508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/20/2019] [Accepted: 05/08/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES A side effect to thoracic epidural anesthesia (TEA) is hypotension induced by central hypovolemia. This study addressed whether early activation (EA) versus late activation (LA) of TEA affects plasma pro-atrial natriuretic peptide (proANP) reflecting deviations in the central blood volume (CBV). We hypothesized that EA TEA would reduce plasma proANP, thus reflecting a decrease in CBV. METHODS A randomized, controlled, single-blinded trial was conducted. Patients undergoing open esophagectomy were randomized to EA (n=25, after induction of general anesthesia) or LA TEA (n=25, after re-established gastric continuity) with the epidural catheter placed at the interspaces Th7-8 or Th8-9. Plasma proANP was determined repetitively along with hemodynamic variables and administration of fluid/vasopressors as postoperative complications were noted. RESULTS With EA TEA, plasma proANP decreased following induction of anesthesia to the end of surgery (13%; 113±68 to 99±49 pmol/L; p=0.026), but that was not the case in the LA group (3%; 97±44 to 94±49 pmol/L; p=0.565) despite equal fluid balance (+1584±582 vs +1560±563 mL; p=0.888). Accordingly, the EA group required excessive treatment with vasopressors to maintain MAP >60 mm Hg during surgery (2.7±2 vs 1.6±1.4 ephedrine boluses; p=0.033 and infusion of phenylephrine for 216±86 vs 58±91 min; p<0.001). Plasma proANP and fluid balance were correlated only for EA patients (r=0.44; 95% CI 0.04 to 0.91; p=0.033). CONCLUSIONS EA TEA reduces plasma proANP indicating that CBV becomes affected. Based on a correlation between plasma proANP and fluid balance, a 2000 mL volume surplus of lactated Ringer's solution is required to maintain plasma proANP stable during open esophagectomy. TRIAL REGISTRATION NUMBER 2014-002036-14 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-002036-14).
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Affiliation(s)
- Rune B Strandby
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Niels H Secher
- Department of Anesthesia, Rigshospitalet, Copenhagen, Denmark
| | - Lars B Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
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Yoshiga C, Dawson EA, Volianitis S, Warberg J, Secher NH. Cardiac output during exercise is related to plasma atrial natriuretic peptide but not to central venous pressure in humans. Exp Physiol 2019; 104:379-384. [DOI: 10.1113/ep087522] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 01/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Chie Yoshiga
- Department of Anaesthesia; The Copenhagen Muscle Research Centre, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Ellen Adele Dawson
- Department of Anaesthesia; The Copenhagen Muscle Research Centre, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Faculty of Science; School of Sport and Exercise Sciences; Liverpool John Moores University; Liverpool UK
| | - Stefanos Volianitis
- Department of Anaesthesia; The Copenhagen Muscle Research Centre, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
- Department of Health Science and Technology; Aalborg University; Aalborg Denmark
| | - Jørgen Warberg
- Department of Biomedicine; The Panum Institute; University of Copenhagen; Copenhagen Denmark
| | - Niels H. Secher
- Department of Anaesthesia; The Copenhagen Muscle Research Centre, Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Fujii N, McNeely BD, Nishiyasu T, Kenny GP. Intradermal administration of atrial natriuretic peptide has no effect on sweating and cutaneous vasodilator responses in young male adults. Temperature (Austin) 2017; 4:406-413. [PMID: 29435479 DOI: 10.1080/23328940.2017.1356433] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 01/27/2023] Open
Abstract
Atrial natriuretic peptide (ANP) increases during exercise in the heat wherein heat loss responses of sweating and cutaneous vasodilatation are activated. Hence ANP might be involved in the regulation of sweating and cutaneous vasodilatation. However, whether ANP directly mediates sweating and cutaneous vasodilatation needs to be clarified. Also, muscarinic receptor activation induces sweating and cutaneous vasodilatation, however, it remains to be determined whether ANP modulates these responses. In this study, in 11 young males (25 ± 5 years), cutaneous vascular conductance and sweat rate were assessed at intradermal microdialysis sites that were continuously perfused with either lactated Ringer (Control) or 3 different concentrations of ANP (0.1, 1, 10 µM). All 4 sites were co-administrated with methacholine, a muscarinic receptor agonist, in a dose-dependent fashion (0.0125, 0.25, 5, 100, and 2000 mM, 25 min for each). ANP at all concentrations did not increase sweat rate and cutaneous vascular conductance as compared with pre-ANP infusion values (all P > 0.05). Methacholine increased both sweat rate and cutaneous vascular conductance (all P ≤ 0.05). However, the responses were unaffected by co-administration of ANP relative to methacholine only, even as assessed in context of the methacholine concentration required to elicit 50% of the maximal response (EC50) (all P > 0.05). We show that exogenous ANP administration intradermally does not directly modulate sweating and cutaneous vasodilatation under room temperature conditions in resting young adults. Further, there is no effect of ANP on muscarinic sweating and cutaneous vasodilatation.
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Affiliation(s)
- Naoto Fujii
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Canada.,Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba City, Japan
| | - Brendan D McNeely
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Canada
| | - Takeshi Nishiyasu
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba City, Japan
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, University of Ottawa, Ottawa, Canada
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Wilson TE. Renal sympathetic nerve, blood flow, and epithelial transport responses to thermal stress. Auton Neurosci 2016; 204:25-34. [PMID: 28043810 DOI: 10.1016/j.autneu.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/28/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022]
Abstract
Thermal stress is a profound sympathetic stress in humans; kidney responses involve altered renal sympathetic nerve activity (RSNA), renal blood flow, and renal epithelial transport. During mild cold stress, RSNA spectral power but not total activity is altered, renal blood flow is maintained or decreased, and epithelial transport is altered consistent with a sympathetic stress coupled with central volume loaded state. Hypothermia decreases RSNA, renal blood flow, and epithelial transport. During mild heat stress, RSNA is increased, renal blood flow is decreased, and epithelial transport is increased consistent with a sympathetic stress coupled with a central volume unloaded state. Hyperthermia extends these directional changes, until heat illness results. Because kidney responses are very difficult to study in humans in vivo, this review describes and qualitatively evaluates an in vivo human skin model of sympathetically regulated epithelial tissue compared to that of the nephron. This model utilizes skin responses to thermal stress, involving 1) increased skin sympathetic nerve activity (SSNA), decreased skin blood flow, and suppressed eccrine epithelial transport during cold stress; and 2) increased SSNA, skin blood flow, and eccrine epithelial transport during heat stress. This model appears to mimic aspects of the renal responses. Investigations of skin responses, which parallel certain renal responses, may aid understanding of epithelial-sympathetic nervous system interactions during cold and heat stress.
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Affiliation(s)
- Thad E Wilson
- Division of Biomedical Sciences, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA.
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