Abstract
BackgroundIt remains debated how much fluid should be administered during surgery. The atrial natriuretic peptide precursor proANP is released by atrial distension and deviations in plasma proANP are reported associated with perioperative fluid balance. We hypothesized that plasma proANP would decrease when the central blood volume is compromised during the abdominal part of robot-assisted hybrid (RE) esophagectomy and that a positive fluid balance would be required to maintain plasma proANP.MethodsPatients undergoing RE (n = 25) or open (OE; n = 25) esophagectomy for gastroesophageal cancer were included consecutively in this prospective observational study. Plasma proANP was determined repetitively during esophagectomy to allow for distinction between the abdominal and thoracic part of the procedure. The RE group was 15° head up tilted during the abdominal procedure.ResultsThe blood loss was 250 (150–375) (RE) and 600 ml (390–855) (OE) (p = 0.01), but the two groups of patients were provided with a similar positive fluid balance: 1705 (1390–1983) vs. 1528 ml (1316–1834) (p = 0.4). However, plasma proANP decreased by 21% (p < 0.01) during the abdominal part of RE carried out during moderate head-up tilt, but only by 11% (p = 0.01) during OE where the patients were supine. Plasma proANP and fluid balance were correlated in the RE-group (r = 0.5 (0.073–0.840), p = 0.02) and tended to correlate in the OE group (r = 0.4 (−0.045–0.833), p = 0.08).ConclusionThe results support that plasma proANP decreases when the central blood volume is compromised and suggest that an about 2200 ml surplus administration of crystalloid is required to maintain plasma proANP during esophagectomy.Trial registrationClinicaltrials.gov (NCT02077673). Registered retrospectively February 12th 2014.
Highlights
IntroductionThe atrial natriuretic peptide precursor proANP is released by atrial distension and deviations in plasma proANP are reported associated with perioperative fluid balance
It remains debated how much fluid should be administered during surgery
stroke volume (SV) decreased (p < 0.01) and systemic vascular resistance (SVR) increased after pneumoperitoneum was established (p = 0.04) but returned to baseline 15 min after start of the procedure (C) (p = 0.04) at a stable mean arterial pressure (MAP) (p = 1.00)
Summary
The atrial natriuretic peptide precursor proANP is released by atrial distension and deviations in plasma proANP are reported associated with perioperative fluid balance. We hypothesized that plasma proANP would decrease when the central blood volume is compromised during the abdominal part of robot-assisted hybrid (RE) esophagectomy and that a positive fluid balance would be required to maintain plasma proANP. Deviations in postoperative outcome relate likely to how well the central blood volume (CBV) is maintained during surgery. Compared to plasma ANP, plasma pro-ANP (proANP) is stable with a half-life of 60–120 min [12] and during cystectomy, plasma proANP decreases with the perioperative blood loss and, increases with a positive fluid balance when administration is based mainly on lactated Ringer’s solution (LR) [13]
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