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Kaul T, Swaminathan R, Chatrath R, Watson D. Vasoactive Pressure Hormones during and after Cardiopulmonary Bypass. Int J Artif Organs 2018. [DOI: 10.1177/039139889001300506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The differences in the pattern of the vasoactive hormone release in response to the stress of surgery and cardiopulmonary bypass (CPB) (pulsatile n = 15 and non pulsatile n = 23) were studied in the adult patients with mitral valve disease (MVD), aortic valve disease (AVD), and the coronary artery disease (CAD). A differential stimulation of the osmoreceptors, baroceptors, renin-angiotensin and the sympathetico-adrenal systems in these patients, resulted in the variations in the pattern of hormone release. Patients with MVD showed a greater stimulation of osmoreceptors, baroceptors and release of Arginine vasopressin (AVP). Renin-angiotensin system was more easily triggered in patients with AVD or CAD; and sympathetico-adrenal system in patients with CAD. The renin-angiotensin-aldosterone axis was better preserved in patients with CAD (r = 0.49, p < 0.001) than in the patients with MVD (r = 0.38, p < 0.02). Plasma renin release showed a significant correlation with noradrenaline release in the patients with MVD (r = 0.47, p < 0.01); but this relationship was lost in the patients with the CAD, due to an excessive noradrenaline release. Pulsatile bypass reduced but did not abolish this response. Under unfavourable conditions, the stress response may persist in the early post-operative period.
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Affiliation(s)
- T.K. Kaul
- Department of Cardiothoracic Surgery, Anesthesiology, and University Department of Chemical Pathology, General Infirmary at Leeds, St. James Hospital Leeds, Cardiac Research Laboratories, Killingbeck Hospital, Leeds - U.K
| | - R. Swaminathan
- Department of Cardiothoracic Surgery, Anesthesiology, and University Department of Chemical Pathology, General Infirmary at Leeds, St. James Hospital Leeds, Cardiac Research Laboratories, Killingbeck Hospital, Leeds - U.K
| | - R.R. Chatrath
- Department of Cardiothoracic Surgery, Anesthesiology, and University Department of Chemical Pathology, General Infirmary at Leeds, St. James Hospital Leeds, Cardiac Research Laboratories, Killingbeck Hospital, Leeds - U.K
| | - D.A. Watson
- Department of Cardiothoracic Surgery, Anesthesiology, and University Department of Chemical Pathology, General Infirmary at Leeds, St. James Hospital Leeds, Cardiac Research Laboratories, Killingbeck Hospital, Leeds - U.K
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Holm J, Szabó Z, Alehagen U, Lindahl TL, Cederholm I. Copeptin Release in Cardiac Surgery–A New Biomarker to Identify Risk Patients? J Cardiothorac Vasc Anesth 2018; 32:245-250. [DOI: 10.1053/j.jvca.2017.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 12/20/2022]
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Effect of remifentanil during cardiopulmonary bypass on incidence of acute kidney injury after cardiac surgery. J Anesth 2017; 31:895-902. [DOI: 10.1007/s00540-017-2419-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
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Lee JJ, Kim YS, Jung HH. Acute serum sodium concentration changes in pediatric patients undergoing cardiopulmonary bypass and the association with postoperative outcomes. SPRINGERPLUS 2015; 4:641. [PMID: 26543775 PMCID: PMC4628041 DOI: 10.1186/s40064-015-1436-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/14/2015] [Indexed: 12/01/2022]
Abstract
The objective of this study is to investigate the degree of serum sodium changes and its association with patient outcomes in pediatrics undergoing heart surgery with cardiopulmonary bypass (CPB). We reviewed the medical records of 275 pediatric patients who underwent heart surgery with CPB. Prior to CPB, hyponatremia (≤135 mmol/L) was observed in 21 of 275 patients. After initiation of CPB, serum sodium decreased significantly and severe hyponatermia (≤130 mmol/L) subsequently developed in 32 patients. At the end of CPB, however, hypernatremia (≥145 mmol/L) developed in 86 patients. The degree of acute serum sodium change during CPB was not associated with patient outcomes. However, the patients with preoperative hyponatremia and those with hypernatremia at the conclusion of CPB had longer hospital stays and higher postoperative complication rates. Lower serum sodium prior to CPB and higher serum sodium at the end of CPB, along with age and duration of the operation, were independently associated with worse in-hospital outcomes. Acute and transient hyponatremia occurred frequently after initiation of CPB, and then serum sodium immediately increased above preoperative levels at the end of CPB. Caution is required to avoid serum sodium overcorrection on the conclusion of CPB.
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Affiliation(s)
- Jeong Jin Lee
- Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young-Soon Kim
- Department of Anaesthesiology and Pain Medicine, Seoul Woman's Hospital, Gyeonggi-do, Bucheon, South Korea
| | - Hae Hyuk Jung
- Department of Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baekryung-ro Gangwon-do, Chuncheon, 200-722 South Korea
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Cui WW, Ramsay JG. Pharmacologic approaches to weaning from cardiopulmonary bypass and extracorporeal membrane oxygenation. Best Pract Res Clin Anaesthesiol 2015; 29:257-70. [DOI: 10.1016/j.bpa.2015.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/09/2015] [Accepted: 03/20/2015] [Indexed: 01/12/2023]
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Yu CH, Cho JH, Jung HY, Lim JH, Jin MK, Kwon O, Hong KD, Choi JY, Yoon SH, Kim CD, Kim YL, Kim GJ, Park SH. A case of transient central diabetes insipidus after aorto-coronary bypass operation. J Korean Med Sci 2012; 27:1109-13. [PMID: 22969261 PMCID: PMC3429832 DOI: 10.3346/jkms.2012.27.9.1109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/25/2012] [Indexed: 11/24/2022] Open
Abstract
Diabetes insipidus (DI) is characterized by excessive urination and thirst. This disease results from inadequate output of antidiuretic hormone (ADH) from the pituitary gland or the absence of the normal response to ADH in the kidney. We present a case of transient central DI in a patient who underwent a cardiopulmonary bypass (CPB) for coronary artery bypass grafting (CABG). A 44-yr-old male underwent a CABG operation. An hour after the operation, the patient developed polyuria and was diagnosed with central DI. The patient responded to desmopressin and completely recovered five days after surgery. It is probable that transient cerebral ischemia resulted in the dysfunction of osmotic receptors in the hypothalamus or hypothalamus-pituitary axis during CPB. It is also possible that cardiac standstill altered the left atrial non-osmotic receptor function and suppressed ADH release. Therefore, we suggest that central DI is a possible cause of polyuria after CPB.
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Affiliation(s)
- Chung-Hoon Yu
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Hee-Yeon Jung
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Jeong-Hoon Lim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Mi-Kyung Jin
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Owen Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Kyung-Deuk Hong
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Ji-Young Choi
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Se-Hee Yoon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - Gun-Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- Clinical Research Center for End Stage Renal Disease, Daegu, Korea
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Effects of aspirin, nimesulide, and SC-560 on vasopressin-induced contraction of human gastroepiploic artery and saphenous vein*. Crit Care Med 2008; 36:193-7. [DOI: 10.1097/01.ccm.0000292155.06797.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Affiliation(s)
- Michael G Fitzsimons
- Department of Anesthesia and Critical Care, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Wei W, Yang CQ, Furnary A, He GW. Greater vasopressin-induced vasoconstriction and inferior effects of nitrovasodilators and milrinone in the radial artery than in the internal thoracic artery. J Thorac Cardiovasc Surg 2005; 129:33-40. [PMID: 15632822 DOI: 10.1016/j.jtcvs.2004.03.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Vasopressin may be a potential cause of spasm in both the radial artery and the internal thoracic artery. This study compared the vasopressin-induced contraction and the effects of milrinone, nitroglycerin, and nitroprusside in vasopressin-induced contraction between the human radial artery and the internal thoracic artery to find effective antispastic methods for arterial grafts. METHODS Concentration-contraction (normalized as force gram produced by each millimeter of the circumference tissue of the artery) curves for vasopressin with or without pretreatment of vasodilators and concentration-relaxation curves for the vasodilators listed were established in the human radial artery (n = 107) and internal thoracic artery (n = 122) segments. RESULTS Vasopressin induced a greater contraction in the radial artery than in the internal thoracic artery (1.9 +/- 0.2 g/mm vs 0.6 +/- 0.1 g/mm, P < .001) with a higher sensitivity (lower EC(50): -9.28 +/- 0.11 vs -8.91 +/- 0.05 log(10)M, P = .006). Milrinone was less potent than nitroglycerin and nitroprusside with higher EC(50) (P < .05) in both the internal thoracic artery and radial artery. Pretreatment with milrinone and nitroprusside significantly inhibited vasopressin contraction in the internal thoracic artery but had little effect in the radial artery. Pretreatment with nitroglycerin did not significantly inhibit the maximum vasopressin contraction in either the internal thoracic artery or radial artery. CONCLUSION The radial artery is more prone to develop spasm related to vasopressin than is the internal thoracic artery, and the effect of vasodilators in vasopressin-induced contraction is different in the radial artery from that in the internal thoracic artery. A more significant prophylactic antispastic effect of milrinone and nitroprusside is demonstrated in the internal thoracic artery than in the radial artery. Therefore, more intensive antispastic treatment is necessary in the radial artery than in the internal thoracic artery during coronary artery bypass grafting.
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Affiliation(s)
- Wei Wei
- Providence Heart Institute, Albery Starr Academic Center, Department of Surgery, Oregon Health and Science University, Portland, USA
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Velissaris T, Tang ATM, Murray M, Mehta RL, Wood PJ, Hett DA, Ohri SK. A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization. Ann Thorac Surg 2004; 78:506-12; discussion 506-12. [PMID: 15276508 DOI: 10.1016/s0003-4975(03)01360-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2003] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) is associated with a systemic stress hormonal response, which can lead to changes in hemodynamics and organ perfusion. We examined perioperative stress hormone release in low-risk patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass. METHODS Fifty-two patients undergoing primary coronary artery bypass grafting by the same surgeon were randomly assigned into either on-pump (n = 26) or off-pump (n = 26) groups. The on-pump coronary artery bypass grafting group underwent mildly hypothermic (35 degrees C) pulsatile cardiopulmonary bypass with arterial line filtration. Arterial blood samples were collected preoperatively, at the end of operation, and at 1, 6, and 24 hours postoperatively. Plasma levels of vasopressin and cortisol were measured using radioimmunoassay. Anesthetic management was standardized. RESULTS Both groups had similar demographic makeup and extent of revascularization (on-pump coronary artery bypass grafting, 2.8 +/- 1.0 grafts versus off-pump coronary artery bypass grafting, 2.4 +/- 0.9 grafts; p = 0.20). No mortality or major morbidity was observed and there were no crossovers. The cardiopulmonary bypass and aortic cross-clamp times in the on-pump coronary artery bypass grafting group were 63 +/- 24 and 33 +/- 11 minutes, respectively. In both groups there was a similar and significant rise in cortisol and vasopressin levels in the early postoperative phase, with a partial recovery toward baseline values observed at 24 hours postoperatively. Repeated measures analysis of covariance showed no significant difference between the groups with time for both hormones (cortisol, p = 0.40; vasopressin, p = 0.30). CONCLUSIONS Despite the avoidance of cardiopulmonary bypass, off-pump coronary artery bypass grafting surgery triggers a systemic stress hormone response that is comparable to conventional surgical revascularization. The neurohormonal environment during beating-heart surgery should be further explored.
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Affiliation(s)
- Theodore Velissaris
- Wessex Cardiothoracic Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom.
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Grigore AM, Grocott HP, Newman MF. Anesthetic management of a patient with a brain tumor for cardiac surgery. J Cardiothorac Vasc Anesth 2000; 14:702-4. [PMID: 11139113 DOI: 10.1053/jcan.2000.18442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A M Grigore
- Department of Anesthesiology, Duke Heart Center, Durham, NC, USA
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Lehot JJ, Villard J, Piriz H, Philbin DM, Carry PY, Gauquelin G, Claustrat B, Sassolas G, Galliot J, Estanove S. Hemodynamic and hormonal responses to hypothermic and normothermic cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1992; 6:132-9. [PMID: 1533164 DOI: 10.1016/1053-0770(92)90186-b] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Normothermic cardiopulmonary bypass (CPB) is used in cardiac surgery at some institutions. To compare hemodynamic and hormonal responses to hypothermic (29 degrees C) and normothermic nonpulsatile CPB, 20 adults undergoing coronary artery bypass graft and/or aortic valve replacement were studied. Hemodynamic measurements and plasma hormone concentrations were obtained from preinduction to the third postoperative hour. The two groups were given similar amounts of anesthetics and vasodilators. Systemic vascular resistance increased only during hypothermic CPB, and heart rate was higher at the end of hypothermic CPB. Postoperative central venous pressure and pulmonary capillary wedge pressure were lower after hypothermic CPB. Oxygen consumption decreased by 45% during hypothermic CPB, did not change during normothermic CPB, but increased similarly in the two groups after surgery; mixed venous oxygen saturation (SvO2) was significantly lower during normothermic CPB. Urine output and composition were similar in the two groups. In both groups, plasma epinephrine, norepinephrine, renin activity, and arginine vasopressin concentrations increased during and after CPB. However, epinephrine, norepinephrine, and dopamine were 200%, 202%, and 165% higher during normothermic CPB than during hypothermic CPB, respectively. Dopamine and prolactin increased significantly during normothermic but not hypothermic CPB. Atrial natriuretic peptide increased at the end of CPB and total thyroxine decreased during and after CPB, with no difference between groups. This study suggests that higher systemic vascular resistance during hypothermic CPB is not caused by hormonal changes, but might be caused by other factors such as greater blood viscosity. A higher perfusion index during normothermic CPB might have allowed higher SvO2.
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Affiliation(s)
- J J Lehot
- Hôpital Cardiovasculaire et Pneumologique L. Pradel, Lyon, France
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Maturi MF, Martin SE, Markle D, Maxwell M, Burruss CR, Speir E, Greene R, Ro YM, Vitale D, Green MV. Coronary vasoconstriction induced by vasopressin. Production of myocardial ischemia in dogs by constriction of nondiseased small vessels. Circulation 1991; 83:2111-21. [PMID: 1904014 DOI: 10.1161/01.cir.83.6.2111] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND We studied the effect of intracoronary administration of arginine-8-vasopressin on blood flow in nondiseased coronary arteries and determined whether this vasoconstriction was severe enough to produce ischemia in 30 dogs. METHODS AND RESULTS In group 1 (n = 6), after vasopressin administration coronary blood flow was decreased by 41% (p less than 0.002) without changes in heart rate or aortic pressure, and left ventricular ejection fraction measured by radionuclide angiocardiography was decreased by 18% (p less than 0.0005). In group 2 (n = 6), ischemia was confirmed by measurement of transmural pH changes. Administration of vasopressin decreased subendocardial pH of the infused zone from 7.40 +/- 0.03 to 7.31 +/- 0.07 (p less than 0.01). The subendocardial pH of the zone not infused with vasopressin did not change. To overcome the intrinsic regulation of blood flow, operating primarily in small coronary arteries, we hypothesized that vasopressin must increase resistance primarily in large rather than small coronary arteries. After intracoronary infusion in group 3 (n = 6), however, most (94%) of the increase in resistance during vasopressin administration was explained by an increase of resistance in small coronary arteries. In group 4 (n = 9), vasopressin decreased coronary blood flow by 50% and decreased local shortening by 90% at a time when systemic hemodynamics were unchanged. Coronary constriction induced by vasopressin, or the recovery from it, also was not altered by cyclooxygenase blockade. CONCLUSIONS Thus, vasopressin produces myocardial ischemia by constricting small, nondiseased coronary arteries severely enough to overcome the competition from normal coronary regulation, and this ischemic event is not mediated by prostaglandin products.
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Affiliation(s)
- M F Maturi
- Experimental Physiology and Pharmacology Section, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md
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Schaff HV, Mashburn JP, McCarthy PM, Torres EJ, Burnett JC. Natriuresis during and early after cardiopulmonary bypass: Relationship to atrial natriuretic factor, aldosterone, and antidiuretic hormone. J Thorac Cardiovasc Surg 1989. [DOI: 10.1016/s0022-5223(19)34282-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yamashita M, Ishihara H, Kudo M, Matsuki A, Oyama T. Plasma vasopressin response to extracorporeal circulation in children. Acta Anaesthesiol Scand 1984; 28:331-3. [PMID: 6741450 DOI: 10.1111/j.1399-6576.1984.tb02071.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Plasma vasopressin levels were measured during open-heart surgery in nine children. The control value of vasopressin was 5.5 +/- 1.5 (s.e.mean) microU/ml. During extracorporeal circulation, a maximum 7.3-fold increase of plasma vasopressin level was demonstrated. This high level of vasopressin was considered to have circulatory effects rather than anti-diuretic effects.
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Malatinský J, Vigas M, Jezová D, Jurcovicová J, Sámel M, Vrsanský D. The effects of open heart surgery on growth hormone, cortisol and insulin levels in man. Hormone levels during open heart surgery. Resuscitation 1984; 11:57-68. [PMID: 6322266 DOI: 10.1016/0300-9572(84)90034-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Plasma growth hormone, cortisol, insulin and blood glucose concentrations were measured intra- and postoperatively in ten patients who underwent open heart surgery with moderate hypothermia. Diazepam-ketamine anaesthesia for 10-20 min failed to precipitate any significant alterations in the levels of measured hormones and blood glucose. In the pre-bypass period of surgery, an increase in cortisol and a slight elevation in growth hormone levels was observed; insulin level showed no change in spite of marked hyperglycaemia. The bypass period, including hypothermia and haemodilution, was accompanied by unchanged cortisol and elevated growth hormone levels, while insulin demonstrated a slight rise which did not correspond with the degree of hyperglycaemia. The post-bypass period with rewarming the restoring spontaneous circulation was characterized by further marked increase in cortisol and growth hormone levels and, in spite of decreasing levels of blood glucose, by a paradoxical elevation in plasma insulin. It is suggested that hypothermia, haemodilution, reduced tissue perfusion affecting endocrine glands, as well as denaturation of some hormones in the oxygenator, participate in the moderate endocrine response, disproportionate to the stress of cardiopulmonary bypass surgery. The rise in hormone levels on terminating bypass seems to be dependent on the improved blood flow to endocrine glands due to recovered spontaneous circulation, rewarming and, as for insulin, presumably even on the reduced inhibitory effect of catecholamines.
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Hickey PR, Buckley MJ, Philbin DM. Pulsatile and nonpulsatile cardiopulmonary bypass: review of a counterproductive controversy. Ann Thorac Surg 1983; 36:720-37. [PMID: 6360057 DOI: 10.1016/s0003-4975(10)60286-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In the controversy over pulsatile and nonpulsatile perfusion, most authors have failed to recognize the fundamental physical differences between the two methods. Pulsatile perfusion is polymorphic and its form varies with both the pulsatile source and the vascular system being perfused; nonpulsatile perfusion is by definition unvarying and uniform. While many studies of hemodynamics, metabolism, organ function, microcirculation, and histology show benefits derived from pulsatile perfusion, others do not. The simplest explanation for these conflicts is that different investigators employ different forms of pulsatile perfusion, only some of which are effective. Failure to quantitate adequately the pulsatile components of flow in these studies prevents differentiation between effective and ineffective forms of pulsatile flow and makes comparison of studies difficult. Future research in this area should be directed toward definition of effective pulsatile perfusion by adequate measurement of the pulsatile components of perfusion.
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Crone LA, Wilson N, Ngsee J, Turnbull KW, Leighton K. Haemodynamic and plasma vasopressin responses with high-dose fentanyl anaesthesia during aorto-coronary bypass operations. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1982; 29:525-32. [PMID: 6128067 DOI: 10.1007/bf03007736] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Twelve male patients were given high dose fentanyl (75-100 microgram.kg-1) anaesthesia with oxygen during elective aorto-coronary bypass operations, and their haemodynamic and vasopressin responses were determined during induction, sternotomy, cardiopulmonary bypass, post-bypass and recovery periods. For comparison, a group of 12 male patients were anaesthetized with morphine, halothane 0.5 per cent, nitrous oxide and oxygen, and were similarly studied. Significant alterations in haemodynamics included increased mean arterial pressure after sternotomy in the fentanyl group, increased heart rate in both groups, increased systemic vascular resistance after sternotomy only in the halothane group, and decreased left ventricular stroke work index in both groups following induction, bypass, and during the recovery periods. Plasma vasopressin levels increased significantly in both groups during the bypass period, but returned to baseline levels following bypass. Serum sodium and osmolality did not change significantly, and urinary sodium and potassium excretion rose with the progress of the operation in both groups. A positive correlation was found between mean arterial pressure and vasopressin only in the halothane group. Systemic vascular resistance was correlated to vasopressin levels in both groups. Vasopressin response in both groups was similar, with significant but relatively low increases in levels during cardiopulmonary bypass. Fentanyl-oxygen anaesthesia did not provide haemodynamic stability in eight of 12 patients.
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Yamashita M, Wakayama S, Matsuki A, Kudo M, Oyama T. Plasma catecholamine levels during extracorporeal circulation in children. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1982; 29:126-9. [PMID: 7066736 DOI: 10.1007/bf03007990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Plasma adrenaline and noradrenaline concentrations have been measured in nine children undergoing cardiac operations involving extracorporeal circulation under neuroleptanaesthesia. Compared to control values, plasma adrenal increased 34-fold and noradrenaline, 2.2-fold during extracorporeal circulation. The increase in plasma catecholamines reported in adults has been confirmed in these children and changes in plasma adrenaline concentrations during extracorporeal circulation were found to be much greater in paediatric patients.
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Kanto J, Viinamäki O, Grönroos M, Lammintausta R, Liukko P. Blood glucose, insulin, antidiuretic hormone and renin activity response during caesarean section performed under general anaesthesia or epidural analgesia. Acta Anaesthesiol Scand 1981; 25:442-4. [PMID: 7041509 DOI: 10.1111/j.1399-6576.1981.tb01683.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Glucose loading caused a significant increase in insulin response (IRI) in patients undergoing caesarean section both under general anaesthesia and under epidural analgesia. After a fast intravenous glucose loading given just before the administration of epidural bupivacaine, similar but more variable serum immunoreactive insulin levels were found as compared with those determined after a slower intravenous glucose infusion in patients under general anaesthesia. Plasma renin activity values did not change significantly in either group, but, differing from general anaesthesia, antidiuretic hormone levels (ADH) increased significantly in patients under epidural analgesia. The changes in IRI and ADH response may be caused by a higher psychic stress reaction of the conscious patients during caesarean section under epidural analgesia.
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Levine FH, Philbin DM, Kono K, Coggins CH, Emerson CW, Austen WG, Buckley MJ. Plasma vasopressin levels and urinary sodium excretion during cardiopulmonary bypass with and without pulsatile flow. Ann Thorac Surg 1981; 32:63-7. [PMID: 7247562 DOI: 10.1016/s0003-4975(10)61376-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The use of pulsatile perfusion during bypass should create a more physiological milieu and thus attenuate the vasopressin stress response. To determine this, 20 patients scheduled for elective coronary artery bypass operation were studied in two groups. Group 1 had a standard nonpulsatile perfusion, and in Group 2 a pulsatile pump was used. Measurements were made before and after anesthesia, after surgical incision, and at 15 and 30 minutes during and after cardiopulmonary bypass. In both groups, vasopressin levels were significantly elevated after sternotomy (4.5 +/- 1.5 to 37 +/- 10 pg/ml in Group 1 and 3.1 +/- 1.2 to 33 +/- 9 pg/ml in Group 2, p less than 0.05) and during bypass (198 +/- 19 pg/ml in Group 1 and 113 +/- 16 pg/ml in Group 2) but were higher in Group 1 (p less than 0.05). With comparable perfusion pressures in both groups, Group 2 required higher flow (4.2 +/- 0.2 versus 3.5 +/- 0.3 L/min, p less than 0.05) and had lower resistance (1,351 +/- 182 versus 1,841 +/- 229 dynes sec cm-5, p less than 0.05) and higher urine Na+ (123 +/- 5 versus 101 +/- 8 mEq/L, p less than 0.05). These data demonstrate that pulsatile flow can significantly attentuate the vasopressin stress response to bypass. Since vasopressin, at these concentrations, is a potent vasoconstrictor and is capable of producing a Na+ diuresis, this may partially explain the higher flow requirements and the decrease in Na+ excretion.
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Oka Y, Wakayama S, Oyama T, Orkin LR, Becker RM, Blaufox MD, Frater RW. Cortisol and antidiuretic hormone responses to stress in cardiac surgical patients. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1981; 28:334-8. [PMID: 7260711 DOI: 10.1007/bf03007799] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The hormonal responses to anaesthesia and cardiac surgery were studied in patients undergoing valve or coronary bypass surgery. Marked increases in antidiuretic hormone levels as a result of surgical stress were seen, and were of approximately equal magnitude in both groups. Although both groups also showed marked increases in plasma cortisol levels in response to operations, this response appeared to be relatively blunted in valve surgery patients, especially at the end of operation and in the intensive care unit. This blunted cortisol response may be a manifestation of exhaustion of adrenocortical reserves in valvular surgical patients whose sympathoadrenal system has already been chronically stimulated by a low output state. The important role of the neuroendocrine system in maintaining homeostasis postoperatively has long been recognized; this relative cortisol deficiency may be aetiologically related to poor postoperative recovery in critically ill valvular surgery patients.
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Cartheuser CF, Komarek J. Effects of vasopressin on the circulation, myocardial dynamics, and left ventricular oxygen consumption in the anaesthetized dog. Basic Res Cardiol 1980; 75:668-82. [PMID: 7447900 DOI: 10.1007/bf01907696] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Philbin DM, Levine FH, Emerson CW, Coggins CH, Buckley MJ, Gerald Austen W. Plasma vasopressin levels and urinary flow during cardiopulmonary bypass in patients with valvular heart disease. J Thorac Cardiovasc Surg 1979. [DOI: 10.1016/s0022-5223(19)38068-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Philbin DM, Coggins CH, Emerson CW, Levine FH, Buckley MJ. Plasma vasopressin levels and urinary sodium excretion during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1979. [DOI: 10.1016/s0022-5223(19)38265-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Philbin DM, Coggins CH. Plasma vasopressin levels during cardiopulmonary bypass with and without profound haemodilution. CANADIAN ANAESTHETISTS' SOCIETY JOURNAL 1978; 25:282-5. [PMID: 667669 DOI: 10.1007/bf03005649] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In cardiopulmonary bypass the effect on plasma vasopressin levels of the addition of whole blood to the pump priming solution was measured. Six patients (Group I) had blood added to the lactated Ringer's solution for the prime, and six patients (Group II) had only lactated Ringer's solution. Neither group had significant changes in plasma vasopressin levels until surgical stimulation occurred. Comparable significant elevations occurred during bypass in both groups. Greater decreases in haematocrit and urinary K+ and greater increases in urinary Na+ occurred in Group II. The degree of haemodilution does not appear to effect plasma vasopressin levels but may alter the degree of electrolyte shift.
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