atrial-natriuretic-factor and Pain--Postoperative

Living donor nephrectomy (LDN) is a unique surgical challenge where surgery is performed on a healthy individual. A new hand-assisted retroperitoneoscopic nephrectomy (HARS) technique was compared to transperitoneal laparoscopic nephrectomy (LAP) and open nephrectomy (OPEN). The aim was to examine the perioperative and postoperative morbidity, and the effects of the different surgical techniques with regard to renal function.. Donors (n=36) were divided into three groups (HARS, LAP and OPEN) according to surgical technique. During the operations, renal function, hormone output, warm ischemia time (WIT) and operating time were recorded. Renal function, complications, convalescence and allograft outcome were followed postoperatively for one year.. OPEN and HARS groups showed similar operation times: 150 (95-218) minutes and 145 (124-225) minutes, respectively. LAP procedures took longer: 218 (163-280) minutes. OPEN had the shortest WIT at 91 (55-315) seconds; LAP had the longest WIT at 207 (100-319) seconds, with HARS at 180 (85-240) seconds. In all groups, glomerular filtration rate and urine production were decreased during surgery. Endoscopic techniques had a higher catecholamine release, and OPEN donors showed higher serum aldosterone. Endoscopic techniques showed shorter convalescence and less postoperative pain compared to OPEN. HARS had a smaller rise in creatinine than LAP, and HARS recipients a better creatinine clearance than the other groups in the early posttransplantation period.. Evaluation of HARS shows that the operation is quick, the donors experience little pain, and recovery time is short. The renal function for donors and recipients is somewhat favorable to open surgery and transperitoneal laparoscopic approaches.

Topics: Adult; Aged; Anesthesia; Atrial Natriuretic Factor; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney; Kidney Transplantation; Laparoscopes; Laparoscopy; Living Donors; Male; Middle Aged; Morbidity; Natriuretic Peptide, Brain; Nephrectomy; Pain, Postoperative; Prospective Studies; Protein Precursors; Recovery Room; Renin-Angiotensin System; Retroperitoneal Space

We investigated whether blocking afferent nociceptive inputs by continuous intra- and postoperative thoracic epidural analgesia (TEA) would decrease plasma concentrations of brain natriuretic peptide (BNP) in patients who were at risk for, or had, coronary artery disease. Twenty-eight patients undergoing major abdominal surgery received either general anesthesia supplemented with a continuous thoracic epidural infusion of 1.25 mg/mL bupivacaine and 1 microg/mL sufentanil (n = 14; TEA) or general anesthesia followed by IV patient-controlled analgesia (n = 14; IV PCA). Visual analog scale pain scores, hemodynamics, plasma catecholamines, cardiac troponin T, atrial natriuretic peptide (ANP), and BNP were serially measured preoperatively, 90 min after skin incision, at arrival in the intensive care unit, and in the morning of the first, second, and third postoperative day. Dynamic visual analog scale scores were significantly less in the TEA group. TEA reduced the postoperative heart rate without affecting other hemodynamic variables. Plasma epinephrine increased perioperatively in both groups but was significantly lower in the TEA group. Baseline ANP and BNP concentrations were similar between groups (TEA 3.4 +/- 1.8 and 27.0 +/- 12.3 pg/mL; IV PCA 3.1 +/- 2.0 and 25.9 +/- 13.0 pg/mL, respectively). ANP and BNP increased perioperatively in both groups, with significantly lower postoperative BNP levels in TEA patients (TEA 92.1 +/- 31.9 pg/mL; IV PCA 161.2 +/- 44.7 pg/mL). No such difference was observed in plasma ANP concentrations. Plasma cardiac troponin T concentrations were within normal limits in both groups at all times. We conclude that continuous perioperative TEA using local anesthetics and opioids attenuated the release of BNP in patients undergoing major abdominal surgery who were at risk for, or had, coronary artery disease.

Topics: Abdomen; Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid; Atrial Natriuretic Factor; Coronary Artery Disease; Epinephrine; Female; Hemodynamics; Humans; Intraoperative Period; Male; Middle Aged; Natriuretic Peptide, Brain; Norepinephrine; Pain Measurement; Pain, Postoperative; Pirinitramide; Postoperative Period; Prospective Studies; Risk Factors; Surgical Procedures, Operative; Ventricular Function, Left

ANF is a potent diuretic, natriuretic and vasorelaxant hormone. The objective of the present study was to examine the effect of opioid receptor stimulation by morphine after surgery on endogenous ANF production and diuresis.. Prospectively, 11 women undergoing surgery for either uterine leiomyomas, chronic pelvic discomfort or desire for definitive contraception by laparotomy were evaluated. Venous samples were collected at fixed times. Concentrations of ANF were measured by commercially available radioimmunoassay test kits. Statistical analysis was performed by the Friedman Two way ANOVA. Kruskal-Wallis 1-way ANOVA and Mann-Whitney U-Wilcoxon Rank Sum W Test. The level of significance was set at probability below 0.05.. There were statistically significant changes in the serum levels of ANF (p=0.0028), in pain score (p<0.0001) and urinary flow rate (p<0.0001) after operation, while the diastolic (p=0.0671) and systolic (p=0.0543) blood pressure showed slightly significant changes.. Our results show that i.v. administered morphine induces a potent diuretic effect via activation of opioid receptors and suggest that this effect is due to the enhanced release of ANF. However the mechanism by which morphine induces the ANF release remains to be evaluated.

Topics: Adult; Analgesics, Opioid; Analysis of Variance; Atrial Natriuretic Factor; Female; Gynecologic Surgical Procedures; Humans; Middle Aged; Morphine; Pain, Postoperative; Postoperative Period; Prospective Studies; Receptors, Opioid