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Krmar RT, Franzén S, Karlsson L, Strandberg H, Törnroth‐Horsefield S, Andresen JK, Jensen BL, Carlström M, Frithiof R. Effect of controlled hypotensive hemorrhage on plasma sodium levels in anesthetized pigs: An exploratory study. Physiol Rep 2023; 11:e15886. [PMID: 38010195 PMCID: PMC10680582 DOI: 10.14814/phy2.15886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 11/29/2023] Open
Abstract
Perioperative hyponatremia, due to non-osmotic release of the antidiuretic hormone arginine vasopressin, is a serious electrolyte disorder observed in connection with many types of surgery. Since blood loss during surgery contributes to the pathogenesis of hyponatremia, we explored the effect of bleeding on plasma sodium using a controlled hypotensive hemorrhage pig model. After 30-min baseline period, hemorrhage was induced by aspiration of blood during 30 min at mean arterial pressure <50 mmHg. Thereafter, the animals were resuscitated with retransfused blood and a near-isotonic balanced crystalloid solution and monitored for 180 min. Electrolyte and water balances, cardiovascular response, renal hemodynamics, and markers of volume regulation and osmoregulation were investigated. All pigs (n = 10) developed hyponatremia. All animals retained hypotonic fluid, and none could excrete net-free water. Urinary excretion of aquaporin 2, a surrogate marker of collecting duct responsiveness to antidiuretic hormone, was significantly reduced at the end of the study, whereas lysine vasopressin, i.e., the pig antidiuretic hormone remained high. In this animal model, hyponatremia developed due to net positive fluid balance and generation of electrolyte-free water by the kidneys. A decreased urinary aquaporin 2 excretion may indicate an escape from antidiuresis.
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Affiliation(s)
- Rafael T. Krmar
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Stephanie Franzén
- Department of Surgical Sciences, anesthesiology and Intensive CareUppsala UniversityUppsalaSweden
| | - Leif Karlsson
- Department of Women's and Children's HealthKarolinska Institutet, Pediatric Endocrinology Unit, Karolinska University HospitalStockholmSweden
| | - Helin Strandberg
- Department of Biochemistry and Structural BiologyLund UniversityLundSweden
| | | | - Jesper K. Andresen
- Department of Cardiovascular and Renal ResearchInstitute of Molecular Medicine, University of Southern DenmarkOdenseDenmark
- Department of UrologyOdense University HospitalOdenseDenmark
| | - Boye L. Jensen
- Department of Cardiovascular and Renal ResearchInstitute of Molecular Medicine, University of Southern DenmarkOdenseDenmark
- Department of UrologyOdense University HospitalOdenseDenmark
| | - Mattias Carlström
- Department of Physiology and PharmacologyKarolinska InstitutetStockholmSweden
| | - Robert Frithiof
- Department of Surgical Sciences, anesthesiology and Intensive CareUppsala UniversityUppsalaSweden
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Näslund E, Lindberg LG, Strandberg G, Apelthun C, Franzén S, Frithiof R. Oxygen saturation in intraosseous sternal blood measured by CO-oximetry and evaluated non-invasively during hypovolaemia and hypoxia - a porcine experimental study. J Clin Monit Comput 2023; 37:847-856. [PMID: 36786963 PMCID: PMC10175432 DOI: 10.1007/s10877-023-00980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE This study intended to determine, and non-invasively evaluate, sternal intraosseous oxygen saturation (SsO2) and study its variation during provoked hypoxia or hypovolaemia. Furthermore, the relation between SsO2 and arterial (SaO2) or mixed venous oxygen saturation (SvO2) was investigated. METHODS Sixteen anaesthetised male pigs underwent exsanguination to a mean arterial pressure of 50 mmHg. After resuscitation and stabilisation, hypoxia was induced with hypoxic gas mixtures (air/N2). Repeated blood samples from sternal intraosseous cannulation were compared to arterial and pulmonary artery blood samples. Reflection spectrophotometry measurements by a non-invasive sternal probe were performed continuously. RESULTS At baseline SaO2 was 97.0% (IQR 0.2), SsO2 73.2% (IQR 19.6) and SvO2 52.3% (IQR 12.4). During hypovolaemia, SsO2 and SvO2 decreased to 58.9% (IQR 16.9) and 38.1% (IQR 12.5), respectively, p < 0.05 for both, whereas SaO2 remained unaltered (p = 0.44). During hypoxia all saturations decreased; SaO2 71.5% (IQR 5.2), SsO2 39.0% (IQR 6.9) and SvO2 22.6% (IQR 11.4) (p < 0.01), respectively. For hypovolaemia, the sternal probe red/infrared absorption ratio (SQV) increased significantly from baseline (indicating a reduction in oxygen saturation) + 5.1% (IQR 7.4), p < 0.001 and for hypoxia + 19.9% (IQR 14.8), p = 0.001, respectively. CONCLUSION Sternal blood has an oxygen saturation suggesting a mixture of venous and arterial blood. Changes in SsO2 relate well with changes in SvO2 during hypovolaemia or hypoxia. Further studies on the feasibility of using non-invasive measurement of changes in SsO2 to estimate changes in SvO2 are warranted.
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Affiliation(s)
- Erik Näslund
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden. .,Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden. .,Department of Anaesthesia, Gävle Hospital, 801 87, Gävle, Sweden.
| | - Lars-Göran Lindberg
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Gunnar Strandberg
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Catharina Apelthun
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Stephanie Franzén
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Section of Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden
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Brignone J, Jensen M, Jensen BL, Assersen KB, Goetze JP, Jødal L, Andersen TB, Magnusdottir SO, Kloster B, Jønler M, Lund L. Protective effect of sacubitril/valsartan (Entresto) on kidney function and filtration barrier injury in a porcine model of partial nephrectomy. Nephrol Dial Transplant 2023; 38:80-92. [PMID: 35704678 DOI: 10.1093/ndt/gfac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Indexed: 01/26/2023] Open
Abstract
Kidney surgery often includes organ ischaemia with a risk of acute kidney injury. The present study tested if treatment with the combined angiotensin II-angiotensin II receptor type 1 and neprilysin blocker Entresto (LCZ696, sacubitril/valsartan) protects filtration barrier and kidney function after ischaemia and partial nephrectomy (PN) in pigs. Single kidney glomerular filtration rate (GFR) by technetium-99m diethylene-triamine-pentaacetate clearance was validated (n = 6). Next, four groups of pigs were followed for 15 days (n = 24) after PN (one-third right kidney, 60 min ischaemia) + Entresto (49/51 mg/day; n = 8), PN + vehicle (n = 8), sham + Entresto (49/51 mg/day; n = 4) and sham + vehicle (n = 4). GFR, diuresis and urinary albumin were measured at baseline and from each kidney after 15 days. The sum of single-kidney GFR (right 25 ± 6 mL/min, left 31 ± 7 mL/min) accounted for the total GFR (56 ± 14 mL/min). Entresto had no effect on baseline blood pressure, p-creatinine, mid-regional pro-atrial natriuretic peptide (MR-proANP), heart rate and diuresis. After 15 days, Entresto increased GFR in the uninjured kidney (+23 ± 6 mL/min, P < .05) and reduced albuminuria from both kidneys. In the sham group, plasma MR-proANP was not altered by Entresto; it increased to similar levels 2 h after surgery with and without Entresto. Fractional sodium excretion increased with Entresto. Kidney histology and kidney injury molecule-1 in cortex tissue were not different. In conclusion, Entresto protects the filtration barrier and increases the functional adaptive response of the uninjured kidney.
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Affiliation(s)
- Juan Brignone
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mia Jensen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Boye L Jensen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
| | - Kasper Bostlund Assersen
- Department of Cardiovascular and Renal Research, University of Southern Denmark, Odense, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, University of Copenhagen, Copenhagen, Denmark
| | - Lars Jødal
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | | | - Brian Kloster
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Jønler
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Lund
- Department of Urology, Aalborg University Hospital, Aalborg, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
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Abstract
Approximately 7% of patients undergoing non-cardiac surgery with general anesthesia develop postoperative acute kidney injury (AKI). It is well-known that general anesthesia may have an impact on renal function and water balance regulation, but the mechanisms and potential differences between anesthetics are not yet completely clear. Recently published large animal studies have demonstrated that volatile (gas) anesthesia stimulates the renal sympathetic nervous system more than intravenous propofol anesthesia, resulting in decreased water and sodium excretion and reduced renal perfusion and oxygenation. Whether this is the case also in humans remains to be clarified. Increased renal sympathetic nerve activity may impair renal excretory function and oxygenation and induce structural injury in ischemic AKI models and could therefore be a contributing factor to AKI in the perioperative setting. This review summarizes anesthetic agents' effects on the renal sympathetic nervous system that may be important in the pathogenesis of perioperative AKI.
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Taavo M, Rundgren M, Frykholm P, Larsson A, Franzén S, Vargmar K, Valarcher JF, DiBona GF, Frithiof R. Role of Renal Sympathetic Nerve Activity in Volatile Anesthesia's Effect on Renal Excretory Function. FUNCTION (OXFORD, ENGLAND) 2021; 2:zqab042. [PMID: 35330795 PMCID: PMC8788708 DOI: 10.1093/function/zqab042] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 08/16/2021] [Indexed: 01/07/2023]
Abstract
Regulation of fluid balance is pivotal during surgery and anesthesia and affects patient morbidity, mortality, and hospital length of stay. Retention of sodium and water is known to occur during surgery but the mechanisms are poorly defined. In this study, we explore how the volatile anesthetic sevoflurane influences renal function by affecting renal sympathetic nerve activity (RSNA). Our results demonstrate that sevoflurane induces renal sodium and water retention during pediatric anesthesia in association with elevated plasma concentration of renin but not arginine-vasopressin. The mechanisms are further explored in conscious and anesthetized ewes where we show that RSNA is increased by sevoflurane compared with when conscious. This is accompanied by renal sodium and water retention and decreased renal blood flow (RBF). Finally, we demonstrate that renal denervation normalizes renal excretory function and improves RBF during sevoflurane anesthesia in sheep. Taken together, this study describes a novel role of the renal sympathetic nerves in regulating renal function and blood flow during sevoflurane anesthesia.
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Affiliation(s)
| | - Mats Rundgren
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Peter Frykholm
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences and Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Stephanie Franzén
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Karin Vargmar
- Department of Biomedical Sciences and Veterinary Public Health, Section of Pathology, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Jean F Valarcher
- Department of Clinical Sciences, Division of Ruminant Medicine, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Gerald F DiBona
- Carver College of Medicine, University of Iowa, Iowa, IA, USA
| | - Robert Frithiof
- Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
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