Plasma pro-atrial natriuretic peptide to estimate fluid balance during open and robot-assisted esophagectomy: a prospective observational study

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BACKGROUND: It 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.

METHODS: Patients 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.

RESULTS: The 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) (-0.045-0.833), (0.073-0.840), (p =" 0.01)" (r =" 0.4" 11% abdominal and balance but by carried correlate correlated during fluid group head-up in moderate oe of only out p =" 0.08).</p" part patients plasma proanp re re-group supine. tended the tilt, to were where>

CONCLUSION: The 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 REGISTRATION: Clinicaltrials.gov ( NCT02077673 ). Registered retrospectively February 12th2014.

OriginalsprogEngelsk
Artikelnummer20
TidsskriftB M C Anesthesiology
Vol/bind17
Antal sider7
ISSN1471-2253
DOI
StatusUdgivet - 3 feb. 2017

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