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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.

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).

Authors+Show Affiliations

Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark runestrandby@hotmail.com.Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark.Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark.Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.Department of Anesthesia, Rigshospitalet, Copenhagen, Denmark.Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31129617

Citation

Strandby, Rune B., et al. "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." Regional Anesthesia and Pain Medicine, 2019.
Strandby RB, Ambrus R, Achiam MP, et al. 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.
Strandby, R. B., Ambrus, R., Achiam, M. P., Goetze, J. P., Secher, N. H., & Svendsen, L. B. (2019). 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. Regional Anesthesia and Pain Medicine, doi:10.1136/rapm-2019-100508.
Strandby RB, et al. 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 May 24; PubMed PMID: 31129617.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Strandby,Rune B, AU - Ambrus,Rikard, AU - Achiam,Michael P, AU - Goetze,Jens P, AU - Secher,Niels H, AU - Svendsen,Lars B, Y1 - 2019/05/24/ PY - 2019/03/07/received PY - 2019/04/20/revised PY - 2019/05/08/accepted PY - 2019/5/27/entrez KW - anesthesia KW - atrial natriuretic factor KW - blood volume KW - epidural KW - operative KW - surgical procedures JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med N2 - 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). SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/31129617/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 L2 - https://linkinghub.elsevier.com/retrieve/pii/rapm-2019-100508 DB - PRIME DP - Unbound Medicine ER -