Responses of vasopressin release in patients with cardiopulmonary bypass anesthetized with enflurane and morphine

Lee, Won Jung; Choo, Young Eun; Song, Won Young; Lee, Jungchul; Kim, Kyu Tae; Lee, Sung Haeng

doi:10.3346/jkms.1989.4.2.71

Cited by 9 publications

(7 citation statements)

References 8 publications

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“…One promising candidate is tolvaptan, an oral selective vasopressin V2-receptor antagonist that causes electrolyte-free water diuresis [ 6 , 7 ]. Water balance in the early postoperative phase is modulated by the level of plasma arginine vasopressin (AVP), which increases in response to operative stress [ 8 , 9 ]. AVP plays an important role in water reabsorption at the renal collecting duct and this increase causes an excessive body water imbalance during the early postoperative phase.…”

Section: Introductionmentioning

confidence: 99%

The effect of tolvaptan on renal excretion of electrolytes and urea nitrogen in patients undergoing coronary artery bypass surgery

Kato

Nakamura

Murata

et al. 2016

BMC Cardiovasc Disord

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BackgroundAdequate fluid management is an important component of patient care following cardiac surgery. Our aim in this study was to determine the benefits of tolvaptan, an oral selective vasopressin-2 receptor antagonist that causes electrolyte-free water diuresis, in postoperative fluid management. We prospectively examined the effect of tolvaptan on renal excretion of electrolytes and urea nitrogen in cardiac surgery patients.MethodsPatients undergoing coronary artery bypass surgery were randomized to receive conventional loop diuretics (Group C, n = 30) or conventional loop diuretic therapy plus tolvaptan (Group T, n = 27). Fractional excretions of sodium (FENA), potassium (FEK) and urea nitrogen (FEUN) were measured in both groups during post-surgical hospitalization.ResultsUrine output was greater with tolvaptan (Group T) than without it (Group C), and some patients in Group C required intravenous as well as oral loop diuretics. Serum sodium concentrations decreased after surgery in Group C, but were unchanged in Group T (postoperative day [POD] 3, 139.8 ± 3.5 vs. 142.3 ± 2.6 mEq/L, p = 0.006). However, postoperative FENA values in Group C did not decrease, and the values were similar in both groups. Serum potassium levels remained lower and FEK values remained higher than the preoperative values, but only in Group C (all p < 0.05). BUN increased postoperatively in both groups, but it remained higher than its preoperative value only in Group C (all p < 0.01). Group T showed an initial increase in BUN, which peaked and then returned to its preoperative value within a week. The FEUN increased postoperatively in both groups, but the change was more pronounced in Group T (POD7, 52.7 ± 9.3 vs. 58.2 ± 6.5 %, p = 0.025).ConclusionsRenal excretion of sodium and potassium reflects the changes in serum concentration in patients treated with tolvaptan. Patients treated only with loop diuretics showed a continuous excretion of sodium and potassium that led to electrolyte imbalance, whereas the combination of loop diuretics and tolvaptan increased renal urea nitrogen elimination. Tolvaptan therefore appears to be an effective diuretic that minimally affects serum electrolytes while adequately promoting the elimination of urea nitrogen from the kidneys in patients undergoing coronary artery bypass surgery.Trial registrationThe present study is registered with the UMIN Clinical Trials Registry (ID: UMIN000011039)

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Section: Introductionmentioning

confidence: 99%

The effect of tolvaptan on renal excretion of electrolytes and urea nitrogen in patients undergoing coronary artery bypass surgery

Kato

Nakamura

Murata

et al. 2016

BMC Cardiovasc Disord

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“…Operative stress induces neurohormonal activation and increases serum AVP levels [8,9]. The measurements of serum AVP levels in 239 critically ill patients and 70 healthy volunteers by Jochberger et al confirmed higher AVP concentrations in patients undergoing cardiac surgery than in patients undergoing noncardiac surgery or who had nonsurgical diseases [21].…”

Section: Discussionmentioning

confidence: 98%

“…Water balance in the early postoperative phase is modulated by the level of plasma arginine vasopressin (AVP), which increases in response to operative stress [8,9]. AVP plays an important role in water reabsorption at the renal collecting duct and this increase causes an excessive body water imbalance during the early postoperative phase.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Tolvaptan on Renal Excretion of Electrolytes and Urea Nitrogen in Patients Undergoing Coronary Artery Bypass Surgery

Ono

Kato

Nakamura

et al. 2016

Journal of Cardiac Failure

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“…Increasing in plasma AVP levels usually begin just after surgical skin incision, peaking during the intra-operative period [3,23] or just after the first postoperative hours [6], followed by an exponential drop during the first 24 postoperative hours in uncomplicated patients [23].…”

Section: Time Course Of Vasopressin In Our Patientsmentioning

confidence: 99%

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

Carvalho¹,

Guillaumon²,

Cintra³

et al. 2011

Rev Bras Cir Cardiovasc

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Objectives: To evaluate plasmatic arginine vasopressin (AVP) levels in patients undergoing scheduled conventional abdominal aortic aneurysm (AAA) repair.Methods: Plasmatic AVP concentrations were measured by radioimmunoassay in 22 non-consecutive adult patients undergoing infra-renal AAA repair. They were under combined general and epidural anesthesia at the following time frames: 1 -pre-operative (T0); 2 -2h (T1) and 6h (T2) after the surgical procedure; 3 -in the morning at the first (T3), second (T4) and third (T5) post-operative days. Some clinical and laboratory variables were also recorded.Results: The mean age of patients was 68±10 years; 17 were males. Plasmatic AVP (mean±SD; pg/mL) was within the normal range at T0 (1.4±0.7; baseline), increasing significantly at T1 (62.6±62.9; P<0.001) and at T2 (31.5±49.7; P<0.001), with a progressive fall, returning to basal levels at T5 (2.1±3.8; P=NS). Positive and statistically significant correlations were found between AVP and glycemia, serum lactate and white blood cells counts, but not with systemic arterial pressure or plasma osmolarity during the postoperative period.Conclusions: Considering that no correlations were found between AVP levels and hemodynamic or plasmatic osmolarity variations in AAA repair, it seems that stress response is mainly secondary to noxious stimulation mediated by the autonomic nervous system that is not completely blocked by anesthetics. Descriptors: Intensive care units. Cardiovascular abnormalities. Receptors, vasopressin. Resumo Objetivos: Avaliar os níveis plasmáticos de vasopressina (AVP) em pacientes submetidos à correção convencional de aneurisma de aorta abdominal (AAA).Métodos: A AVP plasmática foi mensurada por radioimunoensaio em 22 pacientes não-consecutivos submetidos à correção eletiva de AAA infrarrenal sob anestesia geral + epidural nos seguintes momentos: pré-operatório (T0); 2h (T1) e 6h (T2) após a cirurgia; e nas manhãs do primeiro (T3), segundo (T4) e terceiro (T5) dia pós-operatório (PO). Variáveis clínicas e laboratoriais de interesse também foram anotadas.Resultados: A média de idade dos pacientes foi de 68±10 anos, sendo 17 homens. A AVP plasmática (média±DP; pg/ mL) estava dentro de limites normais no T0 (1,4±0,7; basal), aumentando no T1 (62,6±62,9; P<0,001) e no T2 (31,5±49,7; P<0,001), e retornando aos valores basais no T5 (2,1±3,8; RBCCV 44205-1296

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Responses of vasopressin release in patients with cardiopulmonary bypass anesthetized with enflurane and morphine

Cited by 9 publications

References 8 publications

The effect of tolvaptan on renal excretion of electrolytes and urea nitrogen in patients undergoing coronary artery bypass surgery

The effect of tolvaptan on renal excretion of electrolytes and urea nitrogen in patients undergoing coronary artery bypass surgery

The Effect of Tolvaptan on Renal Excretion of Electrolytes and Urea Nitrogen in Patients Undergoing Coronary Artery Bypass Surgery

Vasopressina plasmática em pacientes submetidos à correção de aneurisma de aorta infrarrenal

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