Plasma pro-atrial natriuretic peptide to indicate fluid balance during cystectomy: a prospective observational study

BMJ Open
Kirsten C RasmussenNiels H Secher

Abstract

During surgery the volume of administered fluid is debated. Pro-atrial natriuretic peptide (proANP) is released by atrial distension, and we evaluated the relationship between changes in proANP associated with perioperative fluid balance. Prospective observational study. One university/tertiary centre. The study included patients who underwent radical cystectomy. Plasma for determination of proANP was obtained before surgery, after resection of the bladder, and at the end of surgery for 20 robotic-assisted radical cystectomy (RARC) and 20 open radical cystectomy (ORC) procedures. The blood loss was 1871 (95% CI 1267 to 2475) vs 589 mL (378 to 801) in the ORC and RARC groups (p=0.001), respectively, and fluid balance was positive by 1518 mL (1215 to 1821) during ORC, and by 1858 mL (1461 to 2255) during RARC (p=0.163). Yet, at the end of ORC, plasma proANP was reduced by 23% (14% to 32%, p=0.001), while plasma proANP did not change significantly during RARC. Thus, plasma proANP was associated both with the perioperative blood loss (r= -0.475 (0.632 to -0.101), p=0.002), and with fluid balance (r=0.561 (0.302 to 0.740), p=0.001), indicating that a stable plasma proANP required a fluid surplus by 2.4 L (2.0 to 2.7). There was a co...Continue Reading

References

Oct 1, 1990·Acta Physiologica Scandinavica·S MatzenN H Secher
Sep 5, 2003·Experimental Physiology·Mark P M HarmsNiels H Secher
Dec 17, 2008·British Journal of Anaesthesia·M ZaarP I Johansson
Jun 13, 2009·Acta Anaesthesiologica Scandinavica·M Bundgaard-NielsenH Kehlet
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Jun 28, 2011·Journal of Immunological Methods·Ingrid HunterJens P Goetze
Jan 19, 2012·Anesthesia and Analgesia·Tomas CorcoranKwok M Ho
Jun 5, 2012·British Journal of Anaesthesia·M Doherty, D J Buggy
Jan 30, 2014·Perioperative Medicine·Takehiko IijimaChrister H Svensen
Aug 27, 2014·Clinica Chimica Acta; International Journal of Clinical Chemistry·Jens P GoetzeIngrid Hunter

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