Metabolic Changes Associated with Operation

Mechanism of Postoperative Limitation in Sodium Excretion: The Role of Extracellular Fluid Volume and of Adrenal Cortical Activity1

“…The increased adrenal activity (17-hydroxycorticosteroids and aldosterone) associated with major surgical procedures (4-13, 56) has been frequently implicated as causative of the sodium retention of the postoperative period (1, 3, 5, [10][11][12][13]. There are important observations, however, which suggest that increased endogenous adrenal cortical activity is not essential to the postoperative abnormalities of sodium metabolism (14)(15)(16)(17)(18).…”

“…The mechanisms responsible have, however, not been clearly defined. While increased adrenal cortical secretion such as is generally associated with major surgical procedures (4-9) has been causally implicated by many investigators (1,3,(10)(11)(12)(13), there is considerable evidence that the changes in sodium excretion are independent of variations in the supply of adrenal cortical hormones (14-18).…”

“…The mechanisms responsible have, however, not been clearly defined. While increased adrenal cortical secretion such as is generally associated with major surgical procedures (4-9) has been causally implicated by many investigators (1,3,(10)(11)(12)(13), there is considerable evidence that the changes in sodium excretion are independent of variations in the supply of adrenal cortical hormones (14-18).The extracellular fluid volume, or more precisely that portion of it which is physiologically "effective," has been shown to be a major determinant of renal sodium excretion in normal individuals (19-21). Therefore variation in this volume warrants consideration as a possible etiological factor in the decreased postoperative excretion of sodium.…”

Fluid and Electrolyte Therapy in Cardiac Surgery

“…Majör cerrahi operasyonların ilk 2 saati içinde fonksiyonel izotonik ekstraselüler sıvının anlamlı bir kısmının, cerrahi kanamalardan bağımsız olarak, internal redistribüsyona bağlı azaldığı (cerrahi alan bitişiğindeki bölgelerde ekstraselüler sıvı volümünün azaldığının, cerrahi alandan uzak örneğin splanknik bölgedeki ekstraselüler ve intraselüler sodyum retansiyonunun artığının, S35O 4 ile yapılan ça-lışmalarla) gösterilmiştir (1,5) . Fonksiyonel ekstraselüler sıvı volümündeki azalmanın cerrahi travmanın büyük-lüğü ile de korele olduğunun bilinmesi (1,(3)(4)(5)(6)(7) , major cerrahi hastalarının operasyonu sırasında cerrahi alandan anlamlı sıvı kayıpları olmasa da, bu hastaların çok ciddi sıvı replasman tedavisine gereksinim duyabileceklerini göstermektedir.…”

Discussion on Induced Hypothermia

“…But this reaction could also be initiated in the recovery period, even if it were suspended at the actual time of operation by our anvsthetic technique. In fact there is evidence (MacPhee, 1955) that the very anticipation of an operation is sufficient to fire off these hormonal activities and produce changes in electrolyte excretion. It seemed to us, therefore, that we must turn to animals if we desired to discover whether hypothermia was affecting this particular response to operation.…”