pituitrin and Postoperative-Complications

To summarize the results of randomized controlled trials on the use of vasopressin as a vasopressor agent in cardiac surgery.. Meta-analysis.. Six-hundred-twenty-five adult patients undergoing elective or emergency cardiac surgery.. Arginine vasopressin infusion (n = 313) or control/standard therapy (n = 312).. The rates of perioperative complications and postoperative mortality were used as primary and secondary endpoints, respectively. Fixed and/or random effects models were used to compare pooled odds ratios. Arginine vasopressin reduced the pooled odds ratio (OR) of perioperative complications (OR, 0.33; 95% confidence interval [CI], 0.2-0.54; p < 0.0001). A sensitivity analysis excluding the largest trial showed an unchanged reduction in perioperative complications (OR, 0.35; 95% CI, 0.18-0.69; p = 0.002). When analyzing each perioperative complication separately, vasopressin reduced the pooled OR of vasodilatory shock (OR, 0.4; 95% CI, 0.16-0.97; p = 0.04) and new-onset atrial fibrillation (OR, 0.42; 95% CI, 0.21-0.82; p = 0.01). The pooled OR of postoperative death was not different between patients treated with arginine vasopressin and those receiving standard therapy or placebo (OR, 0.83; 95% CI, 0.45-1.53; p = 0.55). The funnel plot for the primary endpoint suggested a relevant publication bias. All included trials suffered from a high risk of bias.. Our meta-analysis suggests that arginine vasopressin may reduce the rate of perioperative complications in patients undergoing elective or emergency cardiac surgery. No difference in postoperative mortality was observed. An adequately powered multicenter trial is required for reliable estimation of the effects of arginine vasopressin on perioperative complication rates and mortality in cardiac surgical patients.

Topics: Blood Pressure; Cardiac Surgical Procedures; Dose-Response Relationship, Drug; Humans; Hypotension; Infusions, Intravenous; Postoperative Complications; Randomized Controlled Trials as Topic; Vasoconstrictor Agents; Vasopressins

Hyponatremia is the most frequent electrolyte abnormality seen postoperatively in pediatric patients receiving maintenance fluid therapy. Hyponatremia is also common in acute pediatric illness. The main factors contributing to hyponatremia in these conditions are increased secretion of antidiuretic hormone (ADH) and routine use of sodium hypotonic fluids. An increased ADH secretion results in an impaired ability to excrete free water. If the sodium concentration falls to less than 125 mmol/L hyponatremic encephalopathy might develop, resulting in cerebral edema. This is avoided if hypotonic maintenance fluids are not used perioperatively or for rehydration or maintenance during acute critical illness in children.

Topics: Acute Disease; Child; Critical Illness; Fluid Therapy; Humans; Hyponatremia; Perioperative Care; Postoperative Complications; Practice Guidelines as Topic; Vasopressins

There has been considerable recent progress liver transplantation (LTX). The postreperfusion syndrome has clearly defined and typically responds to vasopressin and/or methylene blue when refractory to catecholamine therapy. Diastolic dysfunction and cirrhotic cardiomyopathy are prevalent and important in LTX recipients. The high cardiovascular risk and the increasing medical complexity of the current liver transplant recipient have stimulated the publication of guidelines for cardiovascular assessment before LTX. Cardiac surgery is increasingly more successful in patients with cirrhosis, including simultaneous heart-liver transplantation. Cardiopulmonary bypass in LTX is indicated for hemodynamic rescue and, at some centers, serves as the hemodynamic platform for liver implantation. Although acute renal injury is common after LTX, early diagnosis is now possible with novel biomarkers. Earlier detection of postoperative renal dysfunction may prompt intervention for renal rescue. The metabolic milieu in LTX remains critical. Regular insulin therapy may be more effective than infrequent large bolus therapy for potassium homeostasis. Careful titration of insulin therapy may improve freedom from severe hyperglycemia to decrease morbidity. Since the organization of dedicated anesthesia care teams for LTX improves perioperative outcome, this aspect of perioperative care is receiving systematic attention to optimize safety and quality. The specialty of LTX is likely to continue to flourish even more, given these pervasive advances.

Topics: Anesthesia; Cardiac Surgical Procedures; Humans; Kidney Diseases; Liver Transplantation; Methylene Blue; Postoperative Complications; Reperfusion Injury; Vasoconstrictor Agents; Vasoplegia; Vasopressins

Chronic kidney disease (CKD) often accompanies cardiovascular complications, causing postoperative morbidity and even mortality. Since fluid and electrolyte homeostasis is deregulated in CKD patients, fluid therapy itself may cause postoperative morbidity. Recent studies have shown that forced diuresis through fluid overload offers no renoprotective effect and instead has harmful consequences. Fluid overload should be avoided, and the volume load should be used as the rationale for controlling hemodynamics. The emerging concept of a "zero-fluid balance policy" may be beneficial even for CKD patients. Hydroxyethylstarch might not be preferentially used for CKD patients. Hydroxyethylstarch is not contraindicated for CKD patients except in cases with long-term accumulation caused by increased vascular permeability, such as cases with sepsis, as long as an efficient volume expansion is beneficial to the patient. The regulation of renal function through the endocrine system (i.e., renin-angiotensin-aldosterone and vasopressin) is a key target for protecting the kidney in CKD. The recent development of a receptor blocker targeting these endocrine systems may be beneficial for correcting the fluid balance caused by excess intraoperative fluid therapy. The main issue for fluid therapy in surgical CKD patients may not be the quantity of fluid, but rational intervention affecting the endocrine system.

Topics: Contraindications; Crystalloid Solutions; Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Isotonic Solutions; Kidney; Perioperative Care; Postoperative Complications; Renal Insufficiency, Chronic; Renin-Angiotensin System; Vasopressins

Diabetes insipidus (DI) is a common complication following pituitary surgery and can be transient or permanent. Neurogenic DI occurs following injury to the magnocellular neurons in the hypothalamus that produce and transport arginine vasopressin (AVP) and form the hypothalamo-hypophyseal tract. DI is defined by a constellation of signs and symptoms resulting in dilute high-volume urine output and increasing serum osmolality. The body's inability to concentrate urine leaves the patient dehydrated and leads to metabolic abnormalities that can be life threatening if not recognized and treated in a timely manner with an exogenous AVP analog. The reported incidence of postsurgical central DI varies from 1 to 67%. This wide range likely reflects inconsistencies in the working definition of DI across the literature. Factors affecting the rate of DI include pituitary tumor size, adherence to surrounding structures, surgical approach, and histopathology of pituitary lesion. The likelihood of postoperative DI can be reduced by careful preservation of the neurovascular structures of the hypothalamus, infundibulum, and neurohypophysis. Vigilance and meticulous surgical technique are essential to minimize injury to these critical regions that can lead to postsurgical DI.

Topics: Deamino Arginine Vasopressin; Diabetes Insipidus, Neurogenic; Endoscopy; Humans; Microsurgery; Neurosurgical Procedures; Pituitary Gland; Pituitary Neoplasms; Postoperative Complications; Vasopressins

The perioperative management of pheochromocytomas requires meticulous anesthetic care. There has been considerable progress in its management, recently 3 agents that may be particularly advantageous to the anesthetic team have been identified. Magnesium sulfate is readily available, cheap, safe, and effective for hemodynamic control before tumor resection. It has demonstrated efficacy in adults, children, and in rarer scenarios, such as pheochromocytoma resection in pregnancy and in pheochromocytoma crises. Although only recently entering clinical practice, clevidipine exhibits a pharmacologic profile of great interest, showing efficacy in the management of hypertensive crisis and providing rapid titration and precise hemodynamic control. Its application in the perioperative management of pheochromocytoma before tumor resection recently has been described and likely will expand in the near future. Vasopressin has demonstrated utility in the management of catecholamine-resistant shock after tumor resection. A familiarity with these 3 agents offers anesthesia providers further effective pharmacologic options for managing the hemodynamic challenges inherent to this population before and after tumor resection.

Topics: Adrenal Gland Neoplasms; Anti-Arrhythmia Agents; Combined Modality Therapy; Hemodynamics; Humans; Magnesium Sulfate; Perioperative Care; Pheochromocytoma; Postoperative Complications; Pyridines; Vasoconstrictor Agents; Vasopressins

Cardiac surgery with cardiopulmonary bypass is associated with systemic inflammatory response. In some cases this clinical condition is characterized by severe hypotension due to low systemic vascular resistance during and after cardiopulmonary bypass. A few of these cases do not respond to volume or catecholamines. This condition is known as vasoplegic syndrome. Its etiology is not fully understood today and carries associated morbidity and mortality In this syndrome, vasopressin levels are reduced, as in septic and hypovolemic shock. Supplementary vasopressin improves blood pressure and might be considered as an alternative treatment. Several reports have shown benefits when used alone or in combination with catecholamines. However, further studies are necessary to find the most appropriate use of the drug for vasoplegic syndrome.

Topics: Cardiac Surgical Procedures; Cardiopulmonary Bypass; Humans; Postoperative Complications; Risk Factors; Syndrome; Vasoconstrictor Agents; Vasoplegia; Vasopressins

Pre-operative central diabetes insipidus has been reported in 8-35% of patients affected with craniopharyngioma, and in 70-90% after surgery. The management of postoperative polyuria and polydipsia can be challenging and fluid balance needs to be closely monitored. The classical triphasic pattern of endogenous vasopressin secretion--an initial phase of symptomatic diabetes insipidus occurring 24 hours after surgery; a second phase of inappropriate vasopressin secretion potentially causing hyponatraemia; and a third phase with a return to diabetes insipidus occurring up to 2 weeks later--is often complicated by cerebral salt wasting and thirst disorders. Inadequate adrenal replacement therapy and anticonvulsant agent treatment may increase the risk of life-threatening hyponatraemia in the course of desmopressin (DDAVP) treatment. Appropriate management, in order to avoid life-threatening or disabling electrolyte disturbances, requires a good grasp of the relevant pathophysiology. We review here the pathophysiology and management of the multiple fluid disorders encountered following surgery for craniopharyngiomas.

Topics: Child; Craniopharyngioma; Diabetes Insipidus; Humans; Hyponatremia; Neurosurgical Procedures; Pituitary Neoplasms; Postoperative Complications; Thirst; Vasopressins; Water-Electrolyte Imbalance

Functional diseases of the stomach include visceral hypersensitivity, gastric dysrhythmias, dysfunction of gastric fundus and acommodation, functional diseases of antrum and gastroparesis. A common symptom of this diseases is dyspepsia. A background of dyspepsia state functional and organic abnormalities of upper gastrointestinal tract. The most serious abnormality is gastroparesis. In this review we provide an overview of functional gastroparesis focusing on postoperative and hormonal related gastric dysfunction.

Topics: Animals; Dopamine; Dyspepsia; Gastric Emptying; Gastroesophageal Reflux; Gastrointestinal Motility; Gastroparesis; Glucagon; Humans; Postoperative Complications; Stomach; Vasopressins

Due to the proximity of craniopharyngiomas to the hypothalamus and pituitary gland, most children and adolescents presenting with these tumors will exhibit significant endocrine dysfunction. After treatment, these impairments can become a major cause of morbidity and mortality.. The postoperative course of children undergoing surgery for craniopharyngioma is reviewed.. Even if hormone levels seem to be adequate in the short term after treatment, deficiencies may develop over years and need to be monitored closely.

Topics: Adrenocorticotropic Hormone; Body Weight; Child; Child, Preschool; Craniopharyngioma; Endocrine System; Endocrine System Diseases; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Neurophysins; Pituitary Neoplasms; Postoperative Complications; Protein Precursors; Thyrotropin; Vasopressins

Topics: Animals; Brain; Cardiovascular System; Diabetes Insipidus; Humans; Oropharynx; Osmolar Concentration; Postoperative Complications; Vasopressins; Water-Electrolyte Imbalance

Topics: Benzothiadiazines; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuretics; Humans; Hypothalamo-Hypophyseal System; Pituitary Diseases; Postoperative Complications; Prognosis; Prostaglandin Antagonists; Sodium Chloride Symporter Inhibitors; Vasopressins

Topics: Blood Volume; Child; Craniocerebral Trauma; Deamino Arginine Vasopressin; Dehydration; Diabetes Mellitus, Type 1; Diuresis; Female; Humans; Kinetics; Male; Models, Biological; Neurophysins; Osmolar Concentration; Oxytocin; Pituitary Gland, Posterior; Postoperative Complications; Pregnancy; Pregnancy in Diabetics; Thirst; Urine; Vasopressins

Angiography has become an integral tool in the management of patients with gastrointestinal bleeding. It is used for localizing the site of bleeding and then for controlling the bleeding when more conservative methods of treatment are unsuccessful.

Topics: Angiography; Blood Vessels; Endoscopy; Erythrocytes; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Intestine, Small; Mesenteric Veins; Peptic Ulcer Hemorrhage; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Varicose Veins; Vasopressins

The use of diagnostic and therapeutic angiography for postoperative bleeding which began with its application for bleeding following GI surgery can be ezpanded to almost all other areas of the body. Severe postoperative hemorrhage that previously required a second operation can now be successfully managed by the use of intraarterial or intravenous vasoconstrictors or transcatheter occlusion, thus significantly reducing patient morbidity and mortality. In those patients where a reexploration becomes necessary, diagnostic angiogarphy is a useful guide and helps to tailor the operative procedures.

Topics: Aged; Angiography; Catheterization; Embolization, Therapeutic; Esophageal Diseases; Gastrointestinal Hemorrhage; Gelatin; Hemorrhage; Hip; Humans; Intestine, Small; Kidney Diseases; Male; Pelvic Neoplasms; Postoperative Complications; Stomach Diseases; Tissue Adhesives; Vasopressins

Topics: Brain Diseases; Diabetes Insipidus; Electrolytes; Humans; Hypernatremia; Hyponatremia; Postoperative Complications; Vasopressins; Water; Water Intoxication; Water-Electrolyte Imbalance

The authors present a brief review of the problem of diabetes insipidus in neurosurgical patients, with particular emphasis on the differential diagnosis of postoperative and posttraumatic polyuria and the management of diabetes insipidus in these periods. A listing of drugs currently used in its treatment is given.

Topics: Administration, Intranasal; Benzothiadiazines; Brain Injuries; Carbamazepine; Chlorpropamide; Deamino Arginine Vasopressin; Diabetes Insipidus; Diabetes Mellitus; Diagnosis, Differential; Diuretics; Humans; Hypothalamo-Hypophyseal System; Lypressin; Methods; Polyuria; Postoperative Complications; Sodium Chloride Symporter Inhibitors; Vasopressins; Water-Electrolyte Balance

Topics: Abdomen; Aged; Crohn Disease; Duodenal Diseases; Duodenal Ulcer; Esophageal Achalasia; Esophagitis; Follow-Up Studies; Gastrectomy; Gastritis; Gastrointestinal Hemorrhage; Hematoma; Hernia, Diaphragmatic; Humans; Intestine, Small; Methods; Obesity; Peptic Ulcer Hemorrhage; Postoperative Complications; Stomach Neoplasms; Stomach Ulcer; Vagotomy; Vasopressins; Zollinger-Ellison Syndrome

Topics: Aldosterone; Anesthesia, General; Blood Pressure; Body Fluids; Body Water; Capillary Permeability; Cell Membrane Permeability; Extracellular Space; Humans; Neoplasms; Osmotic Pressure; Plasma Volume; Postoperative Complications; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Accidents, Traffic; Acidosis; Acute Kidney Injury; Adult; Aged; Alkalosis; Aortic Diseases; Aortic Rupture; Body Composition; Calorimetry; Cholecystectomy; Convalescence; Craniocerebral Trauma; Dehydration; Duodenal Ulcer; Endocrine Glands; Female; Homeostasis; Humans; Iliac Artery; Infusions, Parenteral; Kidney; Lung Neoplasms; Male; Metabolism; Middle Aged; Natriuresis; Pancreatitis; Peptic Ulcer Perforation; Postoperative Care; Postoperative Complications; Thoracic Injuries; Thrombosis; Vasopressins; Water-Electrolyte Balance

Topics: Aged; Diuresis; Drainage; Humans; Infant; Kidney; Male; Middle Aged; Natriuresis; Polyuria; Postoperative Complications; Prostatic Hyperplasia; Prostatic Neoplasms; Ureteral Calculi; Ureteral Obstruction; Urinary Bladder Neck Obstruction; Urologic Diseases; Vasopressins; Water-Electrolyte Balance

Arginine vasopressin is a nonapeptide hormone with effects on intracellular water transport and arterial tone that is used in distributive shock and following cardiopulmonary bypass. We sought to evaluate the safety and efficacy of vasopressin infusion on hemodynamics and fluid balance in the early postoperative period after Fontan completion.. We conducted a randomized, double-blinded, placebo-controlled study of vasopressin infusion for 24 hours after cardiopulmonary bypass for Fontan completion. Patient characteristics, hospital outcomes, and measures of hemodynamic parameters, urine output, chest tube drainage, fluid balance, laboratory data, and plasma arginine vasopressin concentrations were collected at baseline and for 48 postoperative hours. Data were analyzed using mixed-effect regressions.. Twenty patients were randomized, 10 to vasopressin and 10 to placebo. Transpulmonary gradient (6.4 ± 0.5 vs 8.3 ± 0.5 mm Hg, P = .011) and chest tube drainage (23 ± 20 vs 40 ± 20 mL/kg, P = .028) for 48 hours after surgery were significantly lower in the vasopressin arm compared to placebo. Arginine vasopressin concentrations were elevated above baseline after surgery until 4 hours post cardiac intensive care unit admission in both arms, and higher in the vasopressin arm during postoperative infusion. No differences in sodium concentration, liver function, or renal function were noted between groups.. Vasopressin infusion after Fontan completion appears safe and was associated with reduced transpulmonary gradient and chest tube drainage in the early postoperative period. A larger multiinstitutional study may show further outcome benefit.

Topics: Antidiuretic Agents; Child, Preschool; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Fontan Procedure; Heart Defects, Congenital; Humans; Incidence; Infusions, Intravenous; Male; Pilot Projects; Postoperative Care; Postoperative Complications; Prospective Studies; Treatment Outcome; United States; Vasopressins; Wisconsin

Orthopedic pain after surgery is very common and difficult to manage. Although intranasal arginine vasopressin (AVP) relieves headache (tension-type headache and migraine mostly), the effect of intranasal AVP on the orthopedic pain after surgery is unknown.. This study investigated the effect of intranasal AVP on orthopedic pain after surgery in a randomized controlled trial with a double-blind design.. The study included 653 orthopedic patients and 661 health volunteers.. Orthopedic pain was analyzed by the visual analogue scales (VAS) and AVP concentration was determined by radioimmunoassay.. (1) intranasal AVP decreased the VAS level in orthopedic patients 2-4 weeks after surgery in a dose-dependent manner; (2) the cerebrospinal fluid (CSF) AVP concentration in orthopedic patients after surgery was higher than that in the health volunteers (38.57 ± 6.11 pg/mL vs 11.74 ± 2.85 pg/mL, p < .01), but had no change in plasma (p > .05); (3) CSF AVP concentration increased significantly in orthopedic patients during 24 hours after the intranasal AVP (p < .05 or .01), which related with VAS level negatively (all p < .01); (4) during 24 hours, intranasal AVP did not influence not only plasma AVP concentration, but also blood pressure, heart rate, respiratory rate and body temperature in orthopedic patients.. The findings contribute valuable information that intranasal AVP can treat orthopedic pain after surgery, and AVP could be an option for pain relief by intranasal administration.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; China; Double-Blind Method; Female; Humans; Male; Middle Aged; Orthopedics; Pain Management; Postoperative Complications; Vasopressins

Although the use of vasopressin has become commonplace in pediatric patients with vasodilatory shock after cardiac surgery, its efficacy and hemodynamic effects have not been systematically documented. Furthermore, previous studies were mainly limited patients with left heart anomalies. To date, the use of vasopressin in patients with right heart anomalies has not yet been reported. To clarify the hemodynamic effects of vasopressin on pediatric patients with vasodilatory shock after cardiopulmonary bypass, 70 consecutive patients, most of whom with right heart anomalies, were retrospectively analyzed in Fuwai Hospital from October 2013 to September 2015. Vasopressin was administered continuously at a dose of 0.0002 to 0.002 u/kg/min. Hemodynamics, urine output, and catecholamine vasopressor doses were compared before and after vasopressin initiation. Results showed that besides the significant increase in blood pressure at 2 h after vasopressin administration, the systemic vascular resistance index also prominently elevated from 894.3 ± 190.8 dyn/s to 1138.2 ± 161.4 dyn/s per cm per m, while the heart rate, right atrial pressure, pulmonary artery pressure had a trend of decline. Subsequently, the fluid requirement, the catecholamine vasopressor requirement both decreased and urine output increased. Lactate concentration showed a later remarkable decline at 12 h since vasopressin administration. All the 70 patients survived to hospital discharge. In conclusion, low dose of vasopressin administration was associated with great and timely hemodynamic improvement for pediatric patients with vasodilatory shock after cardiac surgery without any significant adverse effects.

Topics: Adolescent; Blood Pressure; Cardiopulmonary Bypass; Child; Child, Preschool; Female; Heart Defects, Congenital; Hemodynamics; Humans; Infant; Infant, Newborn; Lactic Acid; Male; Postoperative Complications; Shock; Vasopressins

Vasoplegic syndrome is a common complication after cardiac surgery and impacts negatively on patient outcomes. The objective of this study was to evaluate whether vasopressin is superior to norepinephrine in reducing postoperative complications in patients with vasoplegic syndrome.. This prospective, randomized, double-blind trial was conducted at the Heart Institute, University of Sao Paulo, Sao Paulo, Brazil, between January 2012 and March 2014. Patients with vasoplegic shock (defined as mean arterial pressure less than 65 mmHg resistant to fluid challenge and cardiac index greater than 2.2 l · min · m) after cardiac surgery were randomized to receive vasopressin (0.01 to 0.06 U/min) or norepinephrine (10 to 60 μg/min) to maintain arterial pressure. The primary endpoint was a composite of mortality or severe complications (stroke, requirement for mechanical ventilation for longer than 48 h, deep sternal wound infection, reoperation, or acute renal failure) within 30 days.. A total of 330 patients were randomized, and 300 were infused with one of the study drugs (vasopressin, 149; norepinephrine, 151). The primary outcome occurred in 32% of the vasopressin patients and in 49% of the norepinephrine patients (unadjusted hazard ratio, 0.55; 95% CI, 0.38 to 0.80; P = 0.0014). Regarding adverse events, the authors found a lower occurrence of atrial fibrillation in the vasopressin group (63.8% vs. 82.1%; P = 0.0004) and no difference between groups in the rates of digital ischemia, mesenteric ischemia, hyponatremia, and myocardial infarction.. The authors' results suggest that vasopressin can be used as a first-line vasopressor agent in postcardiac surgery vasoplegic shock and improves clinical outcomes.

Topics: Brazil; Cardiac Surgical Procedures; Double-Blind Method; Female; Humans; Male; Middle Aged; Norepinephrine; Postoperative Complications; Prospective Studies; Shock; Treatment Outcome; Vasoconstrictor Agents; Vasoplegia; Vasopressins

The aim of this study was to investigate the relationship between intraoperative vasopressin infusion and postoperative cardiac enzymes.. A prospective, double-blind, randomized, controlled study.. A single tertiary cardiac center.. One hundred consecutive patients undergoing cardiac surgery with or without cardiopulmonary bypass.. The study was approved by the Institutional Review Board, and patients provided informed consent to participate. Patients were randomized by computer into 2 equal groups: Vasopressin or control. The blinded study included vasopressin administered at a dose of 1.8 U/h or 1.8 mL/h of normal saline, along with catecholamines. The drug was administered continually during surgery while patients needed catecholamines. The intervention was discontinued upon admission to the intensive care unit when information regarding the true character of the drug was reported to the doctor in charge of patients in the intensive care unit by one of the investigators. Primary outcomes were CK-MB and troponin T levels measured at 0, 6, and 12 hours postoperatively.. Of the 100 patients, 8 were excluded; the remaining 92 were randomized to either the vasopressin (n = 47) or control (n = 45) group. There were no significant differences in demographic data between the groups. Postoperatively at 0, 6, and 12 hours, there were no differences in CK-MB (U/l) (37.5 ± 57.9 v 32.0 ± 21.5, 29.4 ± 41.1 v 24.4 ± 23.1, and 21.4 ± 21.3 v. 21.8 ± 32.4, respectively) and troponin T (752.4 ± 638.2 v 762.7 ± 557.1, 753.8 ± 507.3 v 777.6 ± 515.0, and 774.6 ± 572.6 v 698.7 ± 540.2, respectively) values.. Vasopressin infusion has been used to treat catecholamine-unresponsive shock. In this study, intraoperative vasopressin was used safely as a possible first-line drug for treating hypotension; however, it did not increase the levels of cardiac enzymes after cardiac surgery.

Topics: Aged; Aged, 80 and over; Cardiac Surgical Procedures; Double-Blind Method; Female; Follow-Up Studies; Humans; Male; Middle Aged; Perioperative Care; Postoperative Complications; Prospective Studies; Troponin T; Vasoconstrictor Agents; Vasopressins

To evaluate arginine vasopressin (AVP) and copeptin plasma concentrations in patients with vasodilatory shock after cardiac surgery.. Prospective, controlled, clinical study.. Surgical intensive care unit and cardiac surgery ward in a tertiary university teaching hospital.. Thirty-three critically ill patients with vasodilatory shock after cardiac surgery and ten control patients undergoing uncomplicated aorto-coronary bypass surgery.. Hemodynamic, laboratory and clinical data were recorded daily in all patients during the first 7 days after cardiac surgery. At the same time, points blood was withdrawn to determine plasma concentrations of AVP (radioimmunoassay) and copeptin (immunoluminometric assy). Standard tests, a mixed effects model and regression analyses were used for statistical analysis. The course of AVP was significantly different between groups (P < 0.001). While AVP concentrations were lower in the study group on the first postoperative day, they were higher than that in the control group from postoperative day 3 on. There was no difference in the postoperative AVP response between study patients with or without chronic angiotensin-converting enzyme inhibitor therapy. Except during continuous veno-venous hemofiltration, AVP and copeptin correlated significantly with each other (P < 0.001; r = 0.749).. The AVP response to cardiac surgery is significantly different between patients with vasodilatory shock and patients undergoing uncomplicated aorto-coronary bypass surgery. Although no causative relationship between AVP concentrations and cardiovascular instability can be drawn from these results, our data support the hypothesis that inadequately low AVP plasma levels contribute to the failure to restore vascular tone in vasodilatory shock after cardiac surgery.

Topics: Aged; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Drug Therapy, Combination; Female; Glycopeptides; Humans; Male; Postoperative Complications; Prospective Studies; Shock; Vasoconstrictor Agents; Vasodilation; Vasopressins

Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery.. Sixty-two women undergoing abdominal hysterectomy were randomized in a double-blind study to infusion of NaCl 7.5% (HS), NaCl 0.9% (NS4), both 4 ml kg(-1), or NaCl 0.9% 32 ml kg(-1) (NS32) over 20 min. Blood was collected at baseline, 1, 4, and 24 h after surgery (n=34) for the determination of interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12, IL-1ra, and tumour necrosis factor-alpha. Serum cortisol and vasopressin were measured at these time points and 48 h after operation. Epinephrine and norepinephrine (n=26) were quantified at baseline, after infusion, 25 min after incision, 1, and 4 h after surgery. Finally, C-reactive protein was measured at baseline, 24, and 48 h after surgery.. Surgery and anaesthesia induced well-reported changes in the concentrations of cytokines and hormones. The concentration of norepinephrine briefly increased after infusion of HS and NS32 but not NS4 (P<0.05). Epinephrine was increased 25 min after incision in Group NS32 compared with the other groups (P<0.05). No other differences were found between the groups.. Infusion of a clinically relevant dose of hypertonic saline before hysterectomy appears to have limited effect on the postoperative concentration of selected plasma cytokines and the hormonal stress-response.

Topics: Adult; C-Reactive Protein; Cytokines; Double-Blind Method; Epinephrine; Female; Hemoglobins; Hormones; Humans; Hydrocortisone; Hysterectomy; Middle Aged; Norepinephrine; Osmolar Concentration; Postoperative Complications; Preoperative Care; Saline Solution, Hypertonic; Sodium; Stress, Physiological; Vasopressins

Cardiopulmonary bypass (CPB) is associated with a systemic stress hormonal response, which can lead to changes in hemodynamics and organ perfusion. We examined perioperative stress hormone release in low-risk patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.. Fifty-two patients undergoing primary coronary artery bypass grafting by the same surgeon were randomly assigned into either on-pump (n = 26) or off-pump (n = 26) groups. The on-pump coronary artery bypass grafting group underwent mildly hypothermic (35 degrees C) pulsatile cardiopulmonary bypass with arterial line filtration. Arterial blood samples were collected preoperatively, at the end of operation, and at 1, 6, and 24 hours postoperatively. Plasma levels of vasopressin and cortisol were measured using radioimmunoassay. Anesthetic management was standardized.. Both groups had similar demographic makeup and extent of revascularization (on-pump coronary artery bypass grafting, 2.8 +/- 1.0 grafts versus off-pump coronary artery bypass grafting, 2.4 +/- 0.9 grafts; p = 0.20). No mortality or major morbidity was observed and there were no crossovers. The cardiopulmonary bypass and aortic cross-clamp times in the on-pump coronary artery bypass grafting group were 63 +/- 24 and 33 +/- 11 minutes, respectively. In both groups there was a similar and significant rise in cortisol and vasopressin levels in the early postoperative phase, with a partial recovery toward baseline values observed at 24 hours postoperatively. Repeated measures analysis of covariance showed no significant difference between the groups with time for both hormones (cortisol, p = 0.40; vasopressin, p = 0.30).. Despite the avoidance of cardiopulmonary bypass, off-pump coronary artery bypass grafting surgery triggers a systemic stress hormone response that is comparable to conventional surgical revascularization. The neurohormonal environment during beating-heart surgery should be further explored.

Topics: Aged; Biomarkers; Cardiopulmonary Bypass; Coronary Artery Bypass; Coronary Artery Bypass, Off-Pump; Female; Humans; Hydrocortisone; Hypothermia, Induced; Intraoperative Complications; Male; Middle Aged; Postoperative Complications; Prospective Studies; Stress, Physiological; Systemic Inflammatory Response Syndrome; Vasopressins

The aim of this study was to compare micropuncture laparoscopic cholecystectomy (MPLC), with three 3.3-mm cannulas and one 10-mm cannula with conventional laparoscopic cholecystectomy (CLC).. Patients were randomized to undergo either CLC or MPLC. The duration of each operative stage and the procedure were recorded. Interleukin-6 (IL-6), adrenocorticotropic hormone (ACTH), and vasopressin were sampled for 24 h. Visual analogue pain scores (VAPS) and analgesic consumption were recorded for 1 week. Pulmonary function and quality of life (EQ-5D) were monitored for 4 weeks. Statistical analysis was performed using the Mann-Whitney test or Fisher's exact test. Results are expressed as median (interquartile range).. Forty-four patients entered the study, but four were excluded due to unsuspected choledocholithiasis (n = 3) or the need to reschedule surgery (n = 1). The groups were comparable in terms of age, duration of symptoms, and indications for surgery. Total operative time was similar (CLC, 63 [52-81] min vs MPLC 74 [58-95] min; p = 0.126). However, time to place the cannulas after skin incision (CLC, 5:42 [3:45-6:37] min vs MPLC, 7:38 [5:57-10:15] min; p = 0.015) and to clip the cystic duct after cholangiography (CLC, 1:05 [0:40-1:35] min vs MPLC, 3:45 [2:26-7:49] min; p <0.001) were significantly longer for MPLC. Six CLC patients and one MPLC patient required postoperative parenteral opiates (p = 0.04). Oral analgesic consumption was similar in both groups (p = 0.217). Median VAPS were lower at all time points for MPLC, but this finding was not significant (p = 0.431). There were no significant differences in postoperative stay, IL-6, ACTH or vasopressin responses, pulmonary function, or EQ-5D scores.. The thinner instruments did not significantly increase the total duration of the procedure. MPLC reduced the use of parenteral analgesia postoperatively, which may prove beneficial for day case patients, but it did not have a significant impact on laboratory variables, lung function or quality of life.

Topics: Adrenocorticotropic Hormone; Adult; Analgesia; Cholecystectomy; Cholecystectomy, Laparoscopic; Gallbladder; Humans; Interleukin-6; Middle Aged; Nausea; Pain Measurement; Postoperative Complications; Punctures; Quality of Life; Respiratory Function Tests; Stress, Physiological; Vasopressins; Vomiting

To assess the comparative efficacy of perivascular vasopressin and tourniquet in minimizing bleeding and its sequelae at myomectomy.. Between March 1994 and February 1995, 52 women with symptomatic uterine leiomyomas scheduled for myomectomy were entered into a randomized trial comparing vasopressin (26 patients) and tourniquet (26 patients) for hemostasis. Myomectomy was performed after either the perivascular injection of 20 U of vasopressin diluted to 20 mL with normal saline or with the use of a Foley catheter tourniquet around both uterine vessels. The efficacy of each method was measured by comparing differences in pre- and postoperative hemoglobin levels, intraoperative blood pressure, measured blood loss, need for blood transfusion, evidence of postoperative febrile morbidity, complications, and length of hospital stay.. Vasopressin resulted in less blood loss (mean 287.3 mL [standard deviation (SD) 195] versus 512.7 mL [SD 400] for tourniquet [P = .036]). Six of 26 patients in the tourniquet group lost more than 1000 mL of blood, whereas all of the vasopressin subjects lost less than this amount (P = .023). However, there were no significant differences between the two groups in the fall in the hemoglobin level, number of blood transfusions given, intraoperative blood pressure, highest postoperative pulse and temperature, or other complications.. Vasopressin prevents blood loss better than using the tourniquet during myomectomy.

Topics: Adult; Blood Loss, Surgical; Blood Pressure; Blood Transfusion; Female; Hemoglobins; Hemostasis, Surgical; Humans; Leiomyoma; Middle Aged; Postoperative Complications; Tourniquets; Uterine Neoplasms; Vasoconstrictor Agents; Vasopressins

Cardiovascular and hormonal responses to reconstructive abdominal aortic surgery were studied in 20 patients anaesthetized either with moderate-dose fentanyl (20 micrograms kg-1) combined with isoflurane, nitrous oxide and oxygen (n = 10), or with thoracolumbar epidural bupivacaine combined with isoflurane, nitrous oxide and oxygen (n = 10). After the start of operation, hypotension occurred in four patients in the epidural group. In both groups, the aortic cross-clamping caused slight increases both in mean arterial pressure and in calculated systemic vascular resistance, and a significant decrease in cardiac index. At the same time, a marked increase in plasma vasopressin was seen in the fentanyl group. Plasma catecholamines were low in both groups. After aortic declamping, the cardiac index improved in both groups, although two patients in the fentanyl group and four patients in the epidural group were hypotensive. Post-operatively, eight patients in the fentanyl group were hypertensive, versus none in the epidural group, in which bupivacaine-fentanyl was administered epidurally. At the same time, plasma vasopressin and adrenaline increased significantly in both groups, whereas plasma noradrenaline did so only in the fentanyl group. The results suggest that thoracolumbar epidural bupivacaine combined with low-dose isoflurane in nitrous-oxide-oxygen prevents intra-operative hypertension and tachycardia, but it may cause hypotension. Post-operative hypertension and tachycardia as well as the increase in plasma noradrenaline are prevented by epidural administration of bupivacaine-fentanyl.

Topics: Aged; Anesthesia, Epidural; Anesthesia, Inhalation; Anesthesia, Intravenous; Aorta, Abdominal; Blood Pressure; Bupivacaine; Cardiac Output; Female; Fentanyl; Fluid Therapy; Heart Rate; Humans; Hypertension; Hypotension; Intraoperative Complications; Isoflurane; Male; Middle Aged; Norepinephrine; Pain, Postoperative; Postoperative Complications; Tachycardia; Vascular Resistance; Vasopressins

During a period of one year, all patients above the age of 60 with surgical repair of fractured neck of femur were investigated in a prospectively randomized design. A follow-up study included a total number of 56 patients, 32 were allocated to halothane anaesthesia with intubation, 24 received spinal anaesthesia. In addition, 15 patients of the halothane group and 17 patients with spinal anaesthesia were investigated with regard to endocrine stress response. Total mortality was 12.5%, and different anaesthetic management had no influence on the postoperative course. During the operation, adrenaline and ADH increased in both groups. This increase was attenuated by spinal anaesthesia. Noradrenaline was markedly increased even before the operation, and concentrations increased in the halothane group in the course of the operation. There was a linear correlation to time between accident and the beginning of the operation. With regard to endocrine parameters, prompt surgical treatment is beneficial.

Topics: Adrenocorticotropic Hormone; Aged; Aged, 80 and over; Anesthesia, Endotracheal; Anesthesia, Spinal; Blood Pressure; Bupivacaine; Epinephrine; Female; Femoral Neck Fractures; Glycerol; Halothane; Heart Rate; Hormones; Humans; Hydrocortisone; Lactates; Lactic Acid; Male; Mepivacaine; Middle Aged; Norepinephrine; Postoperative Complications; Prospective Studies; Stress, Physiological; Vasopressins

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Gastrointestinal Motility; Humans; Male; Middle Aged; Postoperative Complications; Random Allocation; Time Factors; Vasopressins

A simple technique to inject the synthetic vasoconstrictor agent ornithine-8-vasopressin endoscopically into the prostate has been developed. The method has been assessed by two prospective randomised controlled trials on patients undergoing transurethral resection of the prostate. Results from the first trial, involving 56 patients who had general anaesthesia, were that the mean operative blood loss was 48% less in the treated group, a significant difference (P = 0.05). Results from the second trial, involving 57 patients who had spinal anaesthesia, were that the mean operative blood loss was 75% less in the treated group, a highly significant difference (P = 0.01). The pharmacology of the drug is reviewed, and it seems to be a safe agent which aids transurethral resection. It frequently causes a modest and transient elevation in blood pressure shortly after injection and, although not encountered by the author, it is possible that a more severe elevation necessitating treatment may rarely occur.

Topics: Aged; Anesthesia, General; Anesthesia, Spinal; Clinical Trials as Topic; Endoscopy; Hemorrhage; Hemostasis, Surgical; Humans; Intraoperative Complications; Male; Ornipressin; Postoperative Complications; Prospective Studies; Prostatectomy; Random Allocation; Vasopressins

This prospective, randomized study compares, for the first time, measured blood loss at conization and within 24 hours after using either the cold knife technique or the carbon dioxide laser scalpel. One hundred and ten consecutive patients were evaluated. The median blood loss in the laser group of 55 patients was 4.6 milliliters at, and within, 24 hours after operation compared with 30.1 milliliters in the cold knife group of 55 patients. More important, however, is that the corresponding figures for the range of bleeding were 0.4 to 155.4 milliliters and 5.6 to 1,570.9 milliliters, respectively. The incidence rate for bleeding complications requiring surgical intervention was 1.8 per cet for the laser group and 14.6 per cent for the cold knife group. This difference was statistically significant, p less than 0.015--Fischer's exact test. Conization for treatment of premalignant changes of the cervix uteri will probably remain the treatment of choice for some time to come. It is our opinion that, in the future, laser conization will replace cold knife conization.

Topics: Carcinoma in Situ; Cervix Uteri; Female; Humans; Laser Therapy; Methods; Postoperative Complications; Prospective Studies; Random Allocation; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Uterine Hemorrhage; Vasopressins

Topics: Adult; Age Factors; Anesthesia; Blood Pressure; Cervix Uteri; Clinical Trials as Topic; Female; Heart Rate; Hemorrhage; Humans; Injections; Methods; Middle Aged; Postoperative Complications; Pregnancy; Sutures; Uterine Cervical Diseases; Vasopressins

Topics: Adult; Anesthesia, Spinal; Humans; Male; Middle Aged; Postoperative Complications; Pylorus; Shock, Surgical; Sodium; Stimulation, Chemical; Urine; Vagotomy; Vasopressins; Water

Two case reports present the use of vasopressin for treating refractory hypotension associated with continued angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy prior to general anesthesia for oral surgery. Both patients were treated in an ambulatory dental surgery clinic and took either their ACEI or ARB medication for hypertension within 24 hours prior to undergoing an intubated general anesthetic. Persistent profound hypotension was encountered intraoperatively that was refractory to treatment with traditional methods. However, the ACEI- or ARB-induced refractory hypotension was successfully managed with the administration of vasopressin.

Topics: Anesthesia, General; Anesthetics, General; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Dentistry; Humans; Hypotension; Postoperative Complications; Retrospective Studies; Vasopressins

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma.. In March 2018, routine postoperative fluid restriction to 1000 ml/day for 7 days was instituted for all patients who underwent surgery for pituitary adenoma. These patients were compared with patients who underwent surgery for pituitary adenoma between March 2016 and March 2018, prior to implementation of routine fluid restriction. Patients with preoperative history of diabetes insipidus (DI) or concern for postsurgical DI were excluded. Patients were followed by neuroendocrinologists and neurosurgeons, and sodium levels were checked between 7 and 10 days postoperatively. SIADH was defined by a serum sodium level less than 136 mmol/L, with or without symptoms within 10 days after surgery. Thirty-day readmission was recorded and reviewed to determine underlying reasons.. In total, 82 patients in the fluid-unrestricted cohort and 135 patients in the fluid-restricted cohort were analyzed. The patients in the fluid-restricted cohort had a significantly lower rate of postoperative SIADH than patients in the fluid-unrestricted cohort (5% vs 15%, adjusted OR [95% CI] 0.1 [0.0-0.6], p = 0.01). Higher BMI was associated with lower rate of postoperative SIADH (adjusted OR [95%] 0.9 [0.9-1.0], p = 0.03), whereas female sex was associated with higher rate of SIADH (adjusted OR [95% CI] 3.1 [1.1-9.8], p = 0.03). There was no difference in the 30-day readmission rates between patients in the fluid-unrestricted and fluid-restricted cohorts (4% vs 7%, adjusted OR [95% CI] 0.5 [0-5.1], p = 0.56). Thirty-day readmission was more likely for patients with history of hypertension (adjusted OR [95% CI] 5.7 [1.3-26.3], p = 0.02) and less likely for White patients (adjusted OR [95% CI] 0.3 [0.1-0.9], p = 0.04).. Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.

Topics: Adenoma; Diabetes Insipidus; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sodium; Vasopressins

Topics: Anesthesia; Diverticulum, Colon; Humans; Hypotension; Intestinal Perforation; Male; Middle Aged; Norepinephrine; Postoperative Complications; Receptors, Adrenergic; Sepsis; Sympathomimetics; Vasoconstrictor Agents; Vasopressins

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is an extremely rare cause of hyponatremia post-liver transplantation. A 15-year-old Japanese girl with recurrent cholangitis after Kasai surgery for biliary atresia underwent successful living donor liver transplantation. Peritonitis due to gastrointestinal perforation occurred. Hyponatremia gradually developed but improved after hypertonic sodium treatment. One month later, severe hyponatremia rapidly recurred. We considered the hyponatremia's cause as SIADH. We suspected that tacrolimus was the disease's cause, so we used cyclosporine instead, plus hypertonic sodium plus water intake restriction, which improved the hyponatremia. Symptomatic hyponatremia manifested by SIADH is a rare, serious complication post-liver transplantation.

Topics: Adolescent; Cholangitis; Diagnosis, Differential; Female; Humans; Hyponatremia; Immunosuppressive Agents; Inappropriate ADH Syndrome; Liver Transplantation; Postoperative Complications; Tacrolimus; Vasopressins

Intravenous (IV) fluids are used ubiquitously when children undergo surgical procedures. Until recently, Holliday and Segar's guidelines for calculating maintenance fluids dictated fluid management strategies in postoperative pediatric patients. An increased recognition of hospital-acquired hyponatremia and its associated morbidity has led to a critical re-examination of IV fluid management in this population. Postsurgical patients are at high risk of developing hyponatremia due to the presence of non-osmotic stimuli for antidiuretic hormone release. Recent studies have established that, as they are administered in current practice, hypotonic maintenance fluids are associated with increased rates of hyponatremia. The best available data demonstrate that administration of isotonic fluid reduces hyponatremic risk. In this review, we discuss the collective data available on the subject and offer guidelines for fluid management and therapeutic monitoring.

Topics: Age Factors; Child; Fluid Therapy; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Isotonic Solutions; Neurophysins; Perioperative Care; Postoperative Complications; Protein Precursors; Risk Factors; Treatment Outcome; Vasopressins; Water-Electrolyte Balance

Topics: Acute Kidney Injury; Cardiopulmonary Bypass; Coronary Artery Bypass; Humans; Postoperative Complications; Postoperative Period; Risk Factors; Vasopressins

Topics: Acute Kidney Injury; Cardiopulmonary Bypass; Coronary Artery Bypass; Humans; Postoperative Complications; Postoperative Period; Risk Factors; Vasopressins

Bone cement implantation syndrome (BCIS) is a well-known entity but is poorly understood and rarely reported. It is an important cause of perioperative morbidity and mortality in the patient undergoing cemented hip arthroplasty. BCIS is characterized by hypotension, hypoxia, cardiac arrhythmias, and increased pulmonary vascular resistance and can lead to eventual cardiac arrest if not managed properly. We hereby report a case of delayed presentation of BCIS following cemented right hip arthroplasty.

Topics: Adrenergic alpha-Agonists; Aged, 80 and over; Arthroplasty, Replacement, Hip; Bone Cements; Diagnosis, Differential; Epinephrine; Female; Humans; Hypotension; Norepinephrine; Postoperative Complications; Syndrome; Vasopressins; Ventricular Outflow Obstruction

To report the results of local injection of diluted vasopressin followed by suction curettage as a conservative treatment for women with cervical ectopic pregnancy, who wish to preserve their future fertility.. This was a retrospective chart review in a university hospital and a municipal hospital. We injected diluted vasopressin (Pitressin R, total amount of 4-10 units) transvaginally into the cervix surrounding the gestational sac, but not directly into the gestational sac, and/or the lower segment of the uterine body under transvaginal ultrasonographic guidance. After cessation of fetal heartbeats, we aspirated the conceptus by performing suction curettage. We injected additional vasopressin into the gestational sac in cases with a viable fetus after the initial injection. Forced contraction of the cervical smooth muscle facilitated removal of the conceptus with minimal blood loss during curettage. We measured operative time, total blood loss, complications, and the need for additional treatment.. We included 11 women. Mean patient age, gestational age, and serum human chorionic gonadotrophin (hCG) at the intervention were 31.2±6.4years, 6.0±0.6 weeks, and 18,370±21,570 IU/L, respectively. Mean size of the gestational sac was 19.6±9.5mm. The uterus was successfully preserved without any complications in all patients. All procedures were completed within 15min except for the first case (range: 5-33min). In 4 cases, the conceptus containing a gestational sac was spontaneously extruded en bloc from the external os after the injection. Additional systematic methotrexate administration was required in one case because of remaining villi at the implantation site with persistence of serum hCG levels after the procedure.. Local injection of diluted vasopressin and subsequent suction curettage is a feasible conservative treatment for cervical ectopic pregnancy.

Topics: Adult; Blood Loss, Surgical; Cervix Uteri; Chorionic Gonadotropin; Combined Modality Therapy; Feasibility Studies; Female; Hospitals, Municipal; Hospitals, University; Humans; Injections, Intramuscular; Japan; Operative Time; Postoperative Complications; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Doppler, Color; Vacuum Curettage; Vasoconstrictor Agents; Vasopressins

The perioperative management of pheochromocytoma is challenging for anesthesiologists and persistent hypotension secondary to cathecholamine depletion after tumor resection can be refractory to treatment. A 64-year-old man underwent right adrenalectomy for treatment of massive pheochromocytoma. Doxazosin administration was started and increased gradually to 12 mg daily. He was premedicated with doxazosin on the day of the surgery. Induction was uneventful but there was a sudden increase of blood pressure with tachycardia on handling of tumor which was controlled by intravenous remifentanil, landiolol, diltiazem, and magnesium sulfate. With dissection of the tumor, the blood pressure dropped to 65/40 mmHg, which was resistant to fluid and cathecholamine treatment. After commencement of low dose vasopressin administration (two boluses of 0.08 U followed by 1.6 U x hr(-1)), blood pressure gradually recovered to normal ranges. Low dose vasopressin can be safely used to treat postadrenalectomy hypotension and also can reduce the cathecholamine dose.

Topics: Adrenal Gland Neoplasms; Adrenalectomy; Catecholamines; Drug Resistance; Humans; Hypotension; Male; Middle Aged; Pheochromocytoma; Postoperative Complications; Vasopressins

Surgical manipulation of the pituitary stalk, neurohypophysis or the hypothalamus may disturb control of the plasma sodium level. The factors that might predict the risk of postoperative sodium imbalance are not clear, and were investigated in this study.. A retrospective survey of 129 surgical records for the occurrence of plasma sodium levels outside the normal range, following transsphenoidal procedures. Median patient age was 49 (range 20-78) years, 65 female. 73 of the operated lesions were non-functioning pituitary adenomas. Patients were considered to have impaired plasma sodium balance if the range of 135-145 mmol/L was not maintained.. Of all 129 surgical cases, 68 (53%) experienced an imbalance in sodium levels. Severe sodium imbalance (≥ 149 or ≤ 131 mmol/L) was observed in 28 patients (22%). 13 showed hypernatraemia (median day 1), and 15 hyponatraemia (median day 6). Tumour size was associated with an increased incidence of sodium imbalance, particularly in patients younger than 49 years; surgery resulted in sodium imbalance in 38% of young patients operated on for tumours < 22 mm and in 76% of young patients, operated on for tumours ≥ 22 mm. Overall, tumour size increased with patients' age, and tumour size was less predictive for sodium disturbances in elderly patients. Median time in hospital was 5 days for patients without sodium imbalance, 6 days for patients with hypernatraemia and 11 days for patients with hyponatraemia.. Following pituitary surgery, patients with large tumours, in particular those of young age, are at higher risk for losing control of their plasma sodium level. Increased ADH secretion (hyponatraemia), but not transient diabetes insipidus was associated with a prolonged hospital stay. Postoperative follow-up of patients with sellar tumours should include careful monitoring of plasma sodium levels within the first two postoperative weeks and clear patients' instructions.

Topics: Adenoma; Adult; Aged; Analysis of Variance; Diabetes Insipidus, Neurogenic; Female; Homeostasis; Humans; Hypernatremia; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Sella Turcica; Sodium; Tumor Burden; Vasopressins; Young Adult

Topics: Adult; Blood Gas Analysis; Diabetes Insipidus; Female; Fluid Therapy; Humans; Osmolar Concentration; Perioperative Care; Pituitary Gland; Pituitary Neoplasms; Polyuria; Postoperative Complications; Sodium; Vasopressins; Water-Electrolyte Imbalance

A patient with a giant ovarian tumor weighing about 7 kg was successfully removed by operation. However, her ECG demonstrated ischemic changes after the operation. We report a case of ischemic heart disease due to persistent diuresis after giant ovarian tumor resection. A 75-year-old, 56.5 kg, 143.5 cm woman was admitted to our hospital for ovarian tumor resection. The preoperative ECG showed normal sinus rhythm and no ischemic changes. Both general anesthesia and epidural anesthesia were planed. An epidural catheter was inserted at T12-L1. Anesthesia was induced with propofol 100 mg, fentanyl 100 microg and vecuronium 8 mg under 100% oxygen inhalation. General anesthesia was maintained with sevoflurane while epidural anesthesia was achieved using 0.375% ropivacaine 6 ml. During the operation, blood pressure was 90-110/70-80 mmHg, with SaO2, 100% and heart rate, 70-80 beats x min(-1). The content of tumor was suctioned for 30 minutes. Surgery was successfully finished without any other incidence. After extubation, her ECG changed to atrial fibrillation from normal sinus rhythm and showed ST-T depression. And then her systolic blood pressure became 80 mmHg or below, but we found continued diuresis at about 10 ml x kg(-1) x hr(-1) for over 2 hr. The total of 7 unit vasopressin was intermittently given for vasoconstriction and antidiuresis. Her hemodynamic was immediately restored, and ECG turned to normal ST-T. The patient had uneventful postoperative recovery.

Topics: Aged; Anesthesia, Epidural; Anesthesia, General; Antidiuretic Agents; Atrial Fibrillation; Diuresis; Electrocardiography; Female; Humans; Myocardial Ischemia; Ovarian Neoplasms; Postoperative Complications; Treatment Outcome; Urination Disorders; Vasopressins

Low to moderate doses of vasopressin have been used in the treatment of cathecholamine-dependent vasodilatory shock in sepsis or after cardiac surgery. We evaluated the effects of vasopressin on jejunal mucosal perfusion, gastric-arterial pCO2 gradient and the global splanchnic oxygen demand/supply relationship in patients with vasodilatory shock after cardiac surgery.. Eight mechanically ventilated patients, dependent on norepinephrine to maintain mean arterial pressure (MAP) > or = 60 mmHg because of septic/post-cardiotomy vasodilatory shock and multiple organ failure after cardiac surgery, were included. Vasopressin was sequentially infused at 1.2, 2.4 and 4.8 U/h for 30-min periods. Norepinephrine was simultaneously decreased to maintain MAP at 75 mmHg. At each infusion rate of vasopressin, data on systemic hemodynamics, jejunal mucosal perfusion, jejunal mucosal hematocrit and red blood cell velocity (laser Doppler flowmetry) as well as gastric-arterial pCO2 gradient (gastric tonometry) and splanchnic oxygen and lactate extraction (hepatic vein catheter) were obtained.. The cardiac index, stroke volume index and systemic oxygen delivery decreased and systemic vascular resistance and systemic oxygen extraction increased significantly, while the heart rate or global oxygen consumption did not change with increasing vasopressin dose. Jejunal mucosal perfusion decreased and the arterial-gastric-mucosal pCO2 gradient increased, while splanchnic oxygen or lactate extraction or mixed venous-hepatic venous oxygen saturation gradient were not affected by increasing infusion rates of vasopressin.. Infusion of low to moderate doses of vasopressin in patients with norepinephrine-dependent vasodilatory shock after cardiac surgery induces an intestinal and gastric mucosal vasoconstriction.

Topics: Aged; Carbon Dioxide; Cardiac Surgical Procedures; Female; Hemodynamics; Hemostatics; Humans; Intestinal Mucosa; Jejunum; Laser-Doppler Flowmetry; Male; Middle Aged; Oxygen Consumption; Postoperative Complications; Regional Blood Flow; Shock; Splanchnic Circulation; Vasodilation; Vasopressins

Topics: Adult; Antidiuretic Agents; Cardiac Surgical Procedures; Humans; Hypotension; Male; Polyuria; Postoperative Complications; Substance Withdrawal Syndrome; Vasopressins

A 3-year-old girl presented with osmotic demyelination syndrome after undergoing uneventful neuroendoscopic cystostomy for a growing cystic suprasellar craniopharyngioma following microscopic subtotal resection 1 year previously. Endocrinopathy had well been controlled by hormone replacement therapy and administration of 1-amino-8-d-arginine-vasopressin with serum sodium concentration within the normal range. She presented generalized seizure and fever on postoperative day 7, with hyponatremia beginning on postoperative day 4 and deteriorating despite frequent correction. The serum sodium concentration began to fluctuate on the same day, in the range 111-164 mEq/l, which lasted for 2 weeks, refractory for intense management. Her body temperature also fluctuated between hypo- and hyperthermia not correlated with serum inflammatory markers. Her conscious disturbance progressively deteriorated with spastic paraparesis. T(2)-weighted magnetic resonance (MR) imaging taken on postoperative day 19 revealed hyperintense areas in the pons, external capsule, bilateral thalami, and basal nuclei, which had not been recognized before, suggesting osmotic demyelination syndrome causing central pontine and extrapontine myelinolysis. MR imaging taken on postoperative days 230 and 360 showed some diminished lesions but others persisted and resulted in a cavity. The patient's depressed conscious level did not improve. Suprasellar craniopharyngioma with long-standing hypothalamic dysfunction may be associated with severe osmotic demyelination syndrome even after less invasive surgery, so serum sodium derangement after surgery should be promptly corrected even if only subtle signs are present.

Topics: Brain; Child, Preschool; Consciousness Disorders; Craniopharyngioma; Disease Progression; Female; Fever; Hormone Replacement Therapy; Humans; Hyponatremia; Hypothalamus; Magnetic Resonance Imaging; Myelinolysis, Central Pontine; Nerve Fibers, Myelinated; Neurosurgical Procedures; Pons; Postoperative Complications; Vasopressins; Water-Electrolyte Balance

Topics: Child; Child, Preschool; Eating; Humans; Intraoperative Period; Postoperative Care; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Tonsillectomy; Vasopressins

We report the successful use of vasopressin in the management of hypotension in association with severe right ventricular (RV) failure in two patients with advanced idiopathic pulmonary arterial hypertension. Both patients were pregnant and developed systemic hypotension after delivery by Caesarean section. Placental autotransfusion and possibly oxytocin use were thought to be the major contributing factors in worsening RV function. After the use of vasopressin in both patients, cardiovascular variables improved without untoward effect on RV function, and provided rescue therapy for systemic hypotension in this setting. Vasopressin, a direct vasopressor acting via V1 receptors on the vascular endothelium, has been shown to cause pulmonary vasodilatation experimentally and in animal models of pulmonary hypertension. Its synthetic analogue, terlipressin, has been shown to reduce pulmonary vascular resistance in humans with cirrhosis. Vasopressin may therefore have differential effects on the pulmonary and systemic circulations, allowing systemic pressure to be supported without detrimental effects on the pulmonary circulation.

Topics: Adult; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Hypertension, Pulmonary; Hypotension; Postoperative Complications; Pregnancy; Pregnancy Complications, Cardiovascular; Vasoconstrictor Agents; Vasopressins; Ventricular Dysfunction, Right

Transthoracic intra-aortic balloon pump (IABP) insertion has been a relatively rare and uncommon procedure. However, it is an established beneficial option in patients with severe peripheral vascular disease (PVD) accompanied with bi-lateral femoral arterial occlusion. There are several viable alternatives to trans-aortic IABP insertion, including trans-axillary or in abdominal aorta (requiring a laparotomy). Cardiac surgery has the advantage of an open sternum, facilitating effortless direct intra-aortic balloon (IAB) insertion into the aorta. The IAB can be inserted either through a 9-mm graft or directly into the ascending aorta. During cardiac surgery, direct insertion into the ascending aorta with the balloon tip lying distally in the abdominal aorta is facilitated with an open sternum. The base of the balloon lies approximately 2 cm below the left subclavian and can be confirmed through a trans-esophageal echocardiogram (TEE). Elimination of a graft insertion saves the team from time-consuming maneuvers and additional hemorrhagic complications. In our experience, postoperative vasoplegic syndrome coupled with myocardial edema contributed to patent instability and was treated with vasopressin and transthoracic IAB insertion. The CS 100 (Datascope Corp., Mahwah, NJ) console allowed the ability to time the balloon accurately. This case report details our experience with one such patient and establishes trans-aortic counter-pulsation as a safe and viable option in patients with severe PVD, where percutaneous insertion is precluded or has failed.

Topics: Aged; Cardiomyopathies; Counterpulsation; Edema, Cardiac; Humans; Intra-Aortic Balloon Pumping; Male; Peripheral Vascular Diseases; Postoperative Complications; Vasopressins

A 52-year-old woman with hypertension and Graves' disease was scheduled for surgical removal of a meningioma. Intraoperative events were significant for hypotension requiring a vasopressin infusion. Prophylactic dolasetron was administered to the patient before emergence. The patient's trachea was easily extubated and she was neurologically intact at the end of the surgical procedure. On transport to the neurological intensive care unit, the patient developed torsades de pointes, requiring cardiopulmonary resuscitation, before a return to normal sinus rhythm.

Topics: Adrenergic beta-Antagonists; Amiodarone; Anti-Arrhythmia Agents; Antiemetics; Cardiopulmonary Resuscitation; Electrocardiography; Female; Follow-Up Studies; Graves Disease; Humans; Hypertension; Hypotension; Indoles; Intraoperative Complications; Intubation, Intratracheal; Meningeal Neoplasms; Meningioma; Middle Aged; Postoperative Complications; Propanolamines; Quinolizines; Risk Factors; Torsades de Pointes; Vasoconstrictor Agents; Vasopressins

Topics: Blood Pressure; Female; Humans; Hypertension, Pulmonary; Infant, Newborn; Male; Postoperative Complications; Pulmonary Veno-Occlusive Disease; Vascular Patency; Vascular Resistance; Vasoconstrictor Agents; Vasopressins

Pretransplant renal function is the major determinant of survival after liver transplantation (LTx). Patients with hepatorenal syndrome (HRS) have a poor outcome after LTx compared with patients transplanted without HRS.. To analyze the impact of treatment of HRS before LTx on outcome after transplantation.. The outcome of patients with HRS (n=9) treated with vasopressin analogues before LTx was compared with that of a contemporary control group of patients without HRS (n=27) matched by age, severity of liver failure, and type of immunosuppression.. Cases and controls were similar with respect to pretransplantation characteristics. Three-year survival probability was similar between the two groups (HRS-treated: 100% vs control: 83%, P=0.15). No significant differences were found between the two groups with respect to the incidence of impairment of renal function after LTx (HRS-treated: 22% vs control: 30%), severe infections (22 vs 33%), acute rejection (33 vs 41%), days in Intensive Care Unit (6+/-1 vs 8+/-1), days in hospital (27+/-4 vs 31+/-4), and transfusion requirements (11+/-3 vs 10+/-2 units).. Patients with HRS treated with vasopressin analogues before LTx have a posttransplantation outcome similar to that of patients transplanted with normal renal function. These results suggest that HRS should be treated before LTx.

Topics: Case-Control Studies; Female; Hepatorenal Syndrome; Humans; Kidney; Liver Failure; Liver Transplantation; Lypressin; Male; Middle Aged; Ornipressin; Postoperative Complications; Postoperative Period; Prognosis; Survival Analysis; Terlipressin; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

Managing children with diabetes insipidus (DI) in the perioperative period is complicated and frequently associated with electrolyte imbalance compounded by over- or underhydration. In this study the authors developed and prospectively evaluated a multidisciplinary approach to the perioperative management of DI with a comparison to 19 historical control children. Eighteen children either with preoperative DI or undergoing neurosurgical operations associated with a high risk for developing postoperative DI were identified and managed using a standardized protocol. In all patients in whom DI occurred during or after surgery, a continuous intravenous infusion of aqueous vasopressin was initiated and titrated until antidiuresis was established. Intravenous fluids were given as normal saline and restricted to two thirds of the estimated maintenance rate plus amounts necessary to replace blood losses and maintain hemodynamic stability. In all children managed in this fashion, perioperative serum sodium concentrations were generally maintained between 130 and 150 mEq/L, and no adverse consequences of this therapy developed. In the 24-hour period evaluated, the mean change in serum sodium concentrations between the historical controls was 17.6 +/- 9.2 mEq/L versus 8.36 +/- 6.43 mEq/L in those children managed by the protocol. Hyponatremia occurred less frequently in the children managed with this protocol compared with historical controls.

Topics: Adolescent; Child; Child, Preschool; Clinical Protocols; Deamino Arginine Vasopressin; Diabetes Insipidus; Female; Humans; Hyponatremia; Hypotonic Solutions; Infusions, Intravenous; Male; Neurosurgical Procedures; Perioperative Care; Postoperative Complications; Prospective Studies; Renal Agents; Seizures; Sodium; Vasopressins; Water-Electrolyte Balance

In this study we aimed to establish the frequency of postoperative diabetes insipidus and the incidence and characteristics of abnormalities of thirst in a cohort of patients with craniopharyngioma, in whom neurosurgery had been performed.. Diabetes insipidus was determined by either standard criteria for diagnosis in the immediate postoperative period, or by water deprivation test, in all craniopharyngioma and pituitary tumour patients who underwent surgery in Beaumont Hospital between the years 1986 and 1998. Osmoregulated thirst and vasopressin release were studied during a 2-h infusion of hypertonic (5%) saline followed by a 30-min period of free access to water.. Data on the incidence of postoperative diabetes insipidus was collected in 26 patients with craniopharyngioma and 154 patients with pituitary adenomata. We recruited 16 healthy control patients, 16 patients with cranial diabetes insipidus following pituitary tumour surgery and 16 patients with cranial diabetes insipidus following craniopharyngioma resection for the hypertonic saline infusion study.. Twenty-five patients out of 26 (96%) patients developed diabetes insipidus after surgery for craniopharyngioma, a much higher incidence than after surgery for suprasellar (26/88, 30%, P < 0.001) or intrasellar pituitary tumours (9/66, 14%, P < 0.001). Hypertonic saline infusion identified abnormal thirst responses in five of the 16 craniopharygioma patients studied; all of the pituitary tumour patients had a normal thirst response. Three of the craniopharyngioma patients had adipsic diabetes insipidus whilst two had polydipsic diabetes insipidus.. This study demonstrates following surgery for craniopharyngioma there is a high incidence of cranial diabetes insipidus and a significant incidence of abnormal thirst responses to osmotic stimuli.

Topics: Adult; Blood Pressure; Cohort Studies; Craniopharyngioma; Diabetes Insipidus; Drinking; Female; Humans; Male; Middle Aged; Neurosurgical Procedures; Osmolar Concentration; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Saline Solution, Hypertonic; Thirst; Vasopressins

Clinical results of the Maze procedure for treatment of atrial fibrillation (AF) are excellent, suggesting improved ventricular function after restoring sinus rhythm. However, long-term corresponding effects on the release of cardiac natriuretic peptides and other vasoactive hormones are incompletely investigated after isolated Maze surgery.. Plasma levels of brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP), antidiuretic hormone, aldosterone, and angiotensin II were measured in 15 patients (mean age, 52 +/- 11 years) undergoing isolated surgical Maze (III) procedures for medically refractory AF, preoperatively and 6 months postoperatively. At the time of blood sampling, hemodynamic correlates were obtained at baseline and after 6 and 12 minutes of rapid ventricular pacing at 150 stimulations/minute.. All patients were free of AF at 6-month follow-up. The measured plasma levels of BNP, ANP, and angiotensin II were all significantly lower (p = 0.03) late after the isolated Maze procedure. Cardiac output was significantly higher postoperatively (p < 0.01). Other hemodynamic values and left atrial size were unchanged after surgery. Ventricular pacing caused almost identical hemodynamic changes in atrial pressures before and late after surgery, but the associated plasma ANP response was significantly attenuated postoperatively (p < 0.001).. Levels of cardiac natriuretic peptides and angiotensin II as markers of ventricular function are improved in the long term after clinically successful isolated Maze procedures. ANP response to hemodynamic challenge by ventricular pacing was attenuated postoperatively, possibly due to atrial scarring.

Topics: Adult; Aged; Aldosterone; Angiotensin II; Atrial Fibrillation; Atrial Natriuretic Factor; Chronic Disease; Cryosurgery; Female; Follow-Up Studies; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Neurotransmitter Agents; Postoperative Complications; Vasopressins; Ventricular Dysfunction, Left; Ventricular Function, Left

Topics: Adult; Chorionic Gonadotropin, beta Subunit, Human; Female; Gestational Age; Hemostasis, Endoscopic; Hemostatics; Humans; Laparoscopy; Postoperative Complications; Pregnancy; Pregnancy, Tubal; Treatment Outcome; Ultrasonography, Prenatal; Vasopressins

Abnormal gastric tonometric variables, a surrogate for splanchnic ischemia, occur in approximately 50% of patients at the end of routine cardiac operations and are associated with postoperative morbidity. We sought to determine whether gastric tonometric variables deteriorate after left ventricular assist device insertion and to explore the association between abnormal gastric tonometric variables and vasoconstrictor use.. Nineteen patients who had insertion of a left ventricular assist device were enrolled in a prospective, observational study. Automated air tonometry was used to determine the difference between gastric and arterial partial pressure of carbon dioxide (CO2 gap) at five time points perioperatively.. Compared with baseline, systemic blood flow was significantly increased at the end of operation (1.9 +/- 0.6 versus 2.9 +/- 0.7 L x min(-1) x m(-2), p < 0.0001). Tonometric variables, which were normal at baseline, became abnormal in 90% of patients (baseline CO2 gap 4 +/- 2 mm Hg versus end of operation CO2 gap 24 +/- 15 mm Hg, p < 0.0001). Elevated CO2 gaps correlated with larger doses of norepinephrine (r = 0.69, p = 0.001) and vasopressin (r = 0.88, p < 0.0001). Abnormal gastric tonometric variables at the end of operation correlated with postoperative intensive care unit length of stay (r = 0.70, p = 0.0009) and multiple organ dysfunction score (r = 0.64, p = 0.0033).. Despite a significant increase in systemic blood flow after left ventricular assist device implantation, abnormal gastric tonometric variables developed and were associated with larger vasoconstrictor dose. These data provide evidence that gastric ischemia can develop independently of changes in systemic blood flow and support the potential role of vasoconstrictors as a cause of splanchnic ischemia.

Topics: Acid-Base Equilibrium; Adult; Aged; Carbon Dioxide; Catheters, Indwelling; Critical Care; Dose-Response Relationship, Drug; Female; Gastric Mucosa; Heart Failure; Heart-Assist Devices; Humans; Ischemia; Male; Manometry; Middle Aged; Monitoring, Physiologic; Norepinephrine; Postoperative Complications; Prospective Studies; Splanchnic Circulation; Vasoconstrictor Agents; Vasopressins

A patient undergoing excision of phaeochromocytoma developed refractory hypotension which was complicated by significant intraoperative blood loss. Cardiovascular support with fluids, blood and noradrenaline failed to reverse the hypotension. Introduction of vasopressin successfully reversed the hypotension. The experience with this case suggests that vasopressin may be a useful adjunct in the treatment of catecholamine-resistant hypotension after phaeochromocytoma excision.

Topics: Adrenal Gland Neoplasms; Aged; Humans; Hypotension; Intraoperative Complications; Male; Norepinephrine; Pheochromocytoma; Postoperative Complications; Vasoconstrictor Agents; Vasopressins

We retrospectively investigated the effects of continuous arginine vasopressin (AVP) infusion on systemic hemodynamics, acid/base status, and laboratory variables in patients (mean age [mean +/- SD]= 66.3 +/- 10.1 yr) with catecholamine-resistant septic (n = 35) or postcardiotomy shock (n = 25). Hemodynamic and acid/base data were obtained before; 30 min after; and 1, 4, 12, 24, 48, and 72 h after the start of AVP infusion. Laboratory examinations were recorded before and 24, 48, and 72 h after the start of AVP infusion. For statistical analysis, a mixed-effects model was used. The overall intensive care unit mortality was 66.7%. AVP administration caused a significant increase in mean arterial pressure (+29%) and systemic vascular resistance (+56%), accompanied by a significant decrease in heart rate (-24%) and mean pulmonary arterial pressure (-11%) without any change in stroke volume index. Norepinephrine requirements could be reduced by 72% within 72 h. During AVP infusion, a significant increase in liver enzymes and total bilirubin concentration and a significant decrease in platelet count occurred. Arginine vasopressin was effective in reversing systemic hypotension. However, adverse effects on gastrointestinal perfusion and coagulation cannot be excluded.. In this retrospective analysis, the influence of a continuous infusion of an endogenous hormone (arginine vasopressin) on systemic hemodynamics and laboratory variables was assessed in patients with vasodilatory shock unresponsive to conventional therapy. Arginine vasopressin was effective in reversing systemic hypotension. However, adverse effects on gastrointestinal perfusion and coagulation cannot be excluded.

Topics: Acid-Base Equilibrium; Aged; Cardiac Surgical Procedures; Catecholamines; Critical Care; Drug Resistance; Female; Hemodynamics; Humans; Male; Models, Biological; Norepinephrine; Postoperative Complications; Retrospective Studies; Shock; Shock, Septic; Stroke Volume; Survivors; Vasoconstrictor Agents; Vasopressins

Reduced levels of atrial natriuretic peptide (ANP) has been suggested as a cause of fluid retention after combined Maze and valvular surgery. This study aimed to assess hormonal activation in the perioperative setting of isolated Maze procedures.. Changes in ANP, brain natriuretic peptide (BNP), antidiuretic hormone (ADH), aldosterone, and angiotensin II were measured in 16 patients (mean age 53+/-9 years) without concomitant heart disease undergoing the Maze (III) procedure. Ten matched patients (mean age 56+/-9 years) undergoing multivessel coronary artery bypass grafting served as controls. Measurements with hemodynamic correlates were obtained at baseline and after ventricular pacing (100 stimulations/minute), directly preoperatively, postoperatively and the first postoperative day. Weight gain and diuretic requirements were recorded.. The major differences in hormonal response were significantly higher plasma levels of ADH (Maze preoperative 1.1+/-0.4, postoperative 24.9+/-16.7 pmol/L; controls preoperative 1.1+/-0.1, postoperative 3.7+/-3.5 pmol/L) and aldosterone (Maze preoperative 106+/-94, postoperative 678+/-343 pmol/L; controls preoperative 124+/-79, postoperative 171+/-93 pmol/L) in the Maze group on the first postoperative day (p < 0.001). Preoperative baseline plasma levels of ANP and pulmonary capillary wedge pressures (PCWP) were higher in the Maze group but this difference was abolished by pacing, and postoperatively, ANP levels changed in parallel to the PCWP in both groups. Diuretic requirements were significantly higher in the Maze group.. Substantial increases in ADH and aldosterone were observed after the Maze procedure, indicating these hormones as important determinants in postoperative fluid retention. The role for ANP in this setting may be a less prominent than previously reported.

Topics: Adult; Aged; Aldosterone; Angiotensin II; Atrial Fibrillation; Atrial Natriuretic Factor; Coronary Artery Bypass; Female; Heart Atria; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Postoperative Complications; Vasopressins; Water-Electrolyte Balance

Hyponatremia after cranial vault remodeling has been noted in a pediatric patient population. If left untreated, the patients may develop a clinical hypoosmotic condition that can lead to cerebral edema, increased intracranial pressure, and eventually, to central nervous system and circulatory compromise. The hyponatremia has traditionally been attributed to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH); however, in our patients the treatment has been resuscitation with normal saline as opposed to fluid restriction (the accepted treatment of SIADH), thus placing the diagnosis of SIADH in question. Patients who developed hyponatremia after intracranial injury or surgery were, until recently, grouped together as having SIADH. However, there are diagnosis and treatment differences between SIADH and another distinct but poorly understood disorder that is designated cerebral salt wasting syndrome (CSW). CSW is associated with increased urine output and increased urine sodium concentration and volume contraction, and it is frequently seen after a central nervous system trauma. We therefore developed a prospective study to evaluate the cause of the sodium imbalance.Ten consecutive pediatric patients who underwent intracranial surgery for various craniosynostotic disorders were postoperatively monitored in the pediatric intensive care unit for hemodynamic, respiratory, and fluid management. The first four patients were evaluated for electrolyte changes and overall fluid balance to determine the consistency with which these changes occurred. The remaining six patients had daily (including preoperative) measurement of serum electrolytes, urine electrolytes, urine osmolarity, serum antidiuretic hormone (ADH), aldosterone, and atrial natriuretic hormone (ANH). All patients received normal saline intravenous replacement fluid in the postoperative period. All of the patients developed a transient hyponatremia postoperatively, despite normal saline resuscitation. Serum sodium levels as low as 128 to 133 mEq per liter (normal, 137 to 145 mEq per liter) were documented in the patients. All patients had increased urine outputs through the fourth postoperative day (>1 cc/kg/h). The six patients who were measured had an increased ANH level, with a peak value as high as 277 pg/ml (normal, 25 to 77 pg/ml). ADH levels were low or normal in all but one patient, who had a marked increase in ADH and ANH. Aldosterone levels were variable. On the basis of t

Topics: Aldosterone; Atrial Natriuretic Factor; Child, Preschool; Craniosynostoses; Electrolytes; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Infant; Infusions, Intravenous; Male; Postoperative Complications; Prospective Studies; Resuscitation; Skull; Sodium; Sodium Chloride; Vasopressins

Topics: Cardiopulmonary Bypass; Humans; Hypotension; Postoperative Complications; Vasopressins

a) To determine if antidiuretic hormone (ADH) is elevated in patients undergoing spinal fusion, especially in those who have clinical evidence of syndrome of inappropriate antidiuretic hormone (SIADH); b) to evaluate the relationship between ADH secretion and the secretion of atrial natriuretic peptide (ANP).. Tertiary care pediatric intensive care unit (ICU) in a university hospital.. A prospective cross-sectional, observational study with factorial design.. Thirty patients > or = 10 yrs of age undergoing spinal fusion admitted to the ICU for postoperative care.. Patients underwent anterior, posterior, or both anterior/posterior spinal fusion. Blood was collected for serial measurements of ADH, ANP and serum electrolyte levels. Heart rate, blood pressure and central venous pressure were measured.. Thirty children were studied. Nineteen had idiopathic scoliosis, nine had neuromuscular scoliosis, one had Marfan's disease, and one had congenital scoliosis. Ten (33%) children met clinical criteria of SIADH. There was no difference in duration of surgery, blood loss, volume of iv fluid administration pre- and intraoperatively, or type of scoliosis between those who developed SIADH and those who did not. Hemodynamic variables were similar in both groups. ADH levels increased in both groups immediately postoperatively and at 6 hrs after surgery, but were much more elevated in those patients with SIADH. Patients with SIADH also had significantly higher ADH levels preoperatively. In relation to serum osmolality, ADH was considerably higher in those with SIADH compared with those who did not. Although ANP values tended to be higher in the group with SIADH, this did not reach statistical significance.. SIADH occurs in a subset of children who undergo spinal fusion. The diagnosis of SIADH can be made easily using clinical parameters which are well-defined. In the face of SIADH, continued volume expansion may be harmful, and should therefore be avoided.

Topics: Adolescent; Analysis of Variance; Atrial Natriuretic Factor; Cross-Sectional Studies; Electrolytes; Female; Hemodynamics; Humans; Inappropriate ADH Syndrome; Intensive Care Units, Pediatric; Male; Postoperative Complications; Prospective Studies; Scoliosis; Sodium; Spinal Fusion; Vasopressins

We evaluated the causal role of glucocorticoid deficiency in the hyponatremia that developed in a 57-year-old Japanese man with hypothyroidism following the performance of a total thyroidectomy for laryngeal cancer. The plasma concentration of vasopressin (1.78 pg/ml) was not suppressed in the presence of hyponatremia (125 mEq/l). The urinary excretion of sodium was increased, and the plasma renin activity and plasma aldosterone concentration were suppressed. The infusion of hypertonic saline increased the plasma osmolality, but not the plasma concentration of vasopressin. An oral water load (20 ml/kg of body weight) did not suppress the plasma vasopressin level or induce diuresis. Pretreatment with hydrocortisone normalized the response of plasma vasopressin to the water load was well as the diuretic response during the hypothyroid state. The urinary excretion of 17-hydroxycorticosteroids was below normal in the hypothyroid state in the face of normal serum cortisol concentration. The correction of the hypothyroidism returned these abnormalities to normal. A disturbed metabolism of glucocorticoid may have been responsible for the hyponatremia and disturbance in plasma vasopressin regulation observed in this hypothyroid patient.

Topics: Diuresis; Glucocorticoids; Humans; Hydrocortisone; Hyponatremia; Hypothyroidism; Laryngeal Neoplasms; Male; Middle Aged; Postoperative Complications; Thyroidectomy; Vasopressins

We report a 45 y old male patient with severe hypodipsia, but intact vasopressin secretion and maximal renal response to vasopressin. The patient presented during hot summer days, 18 months after a frontal lobe hemorrhage due to a ruptured aneurysm, with severe hypernatremia (171 mmol/L) and a plasma osmolality of 348 mosm/kg. He was awake and had no interest in fluid intake. After initial correction, a thirst test for 36 hours was performed. Plasma osmolality rose from 295 to 320, urine osmolality rose from 220 to 700 mosm/kg, while plasma vasopressin levels increased more than 3-fold. Throughout the test the patient did not exhibit appreciable thirst. The intact osmoregulation of vasopressin as evidenced by the plasma levels and the elicited renal response, indicates that a selective acquired disturbance of thirst is present. Whether the thirst center is destroyed or/and thirst recognition (frontal lobe affection) is disturbed primarily, can not be decided.

Topics: Aneurysm, Ruptured; Brain Mapping; Cerebral Hemorrhage; Frontal Lobe; Humans; Hypernatremia; Intracranial Aneurysm; Magnetic Resonance Imaging; Male; Middle Aged; Perceptual Disorders; Postoperative Complications; Thirst; Vasopressins; Water-Electrolyte Balance

Hyponatremia after pituitary surgery is presumed to be due to antidiuresis; however, detailed prospective investigations of water balance that would define its pathophysiology and true incidence have not been established. In this prospective study, the authors documented water balance in patients for 10 days after surgery, monitored any sodium dysregulation, further characterized the pathophysiology of hyponatremia, and correlated the degree of intraoperative stalk and posterior pituitary damage with water balance dysfunction. Ninety-two patients who underwent transsphenoidal pituitary surgery were studied. To evaluate posterior pituitary damage, a questionnaire was completed immediately after surgery in 61 patients. To examine the osmotic regulation of vasopressin secretion in normonatremic patients, water loads were administered 7 days after surgery. Patients were categorized on the basis of postoperative plasma sodium patterns. After pituitary surgery, 25% of the patients developed spontaneous isolated hyponatremia (Day 7 +/- 0.4). Twenty percent of the patients developed diabetes insipidus and 46% remained normonatremic. Plasma arginine vasopressin (AVP) was not suppressed in hyponatremic patients during hypoosmolality or in two-thirds of the normonatremic patients after water-load testing. Only one-third of the normonatremic patients excreted the water load and suppressed AVP normally. Hyponatremic patients were more natriuretic, had lower dietary sodium intake, and had similar fluid intake and cortisol and atrial natriuretic peptide (ANP) levels compared with normonatremic patients. Normnonatremia, hyponatremia, and diabetes insipidus were associated with increasing degrees of surgical manipulation of the posterior lobe and pituitary stalk during surgery. The pathophysiology of hyponatremia after transsphenoidal surgery is complex. It is initiated by pituitary damage that produces AVP secretion and dysfunctional osmoregulation in most surgically treated patients. Additional events that act together to promote the clinical expression of hyponatremia include nonatrial natriuretic peptide-related excess natriuresis, inappropriately normal fluid intake and thirst, as well as low dietary sodium intake. Patients should be monitored closely for plasma sodium, plentiful dietary sodium replacement, mild fluid restriction, and attention to symptoms of hyponatremia during the first 2 weeks after transsphenoidal surgery.

Topics: Adult; Arginine Vasopressin; Atrial Natriuretic Factor; Child; Diabetes Insipidus; Diuresis; Female; Fluid Therapy; Humans; Hydrocortisone; Hyponatremia; Incidence; Intraoperative Complications; Male; Natriuresis; Pituitary Diseases; Pituitary Gland; Pituitary Gland, Posterior; Postoperative Complications; Prospective Studies; Renal Agents; Sodium; Sodium, Dietary; Sphenoid Bone; Thirst; Vasopressins; Water; Water-Electrolyte Balance; Water-Electrolyte Imbalance

A prospective observational study of the pathophysiology of sodium and water disorders in patients with pituitary region tumours after surgical excision was carried out in 20 patients. Serial pre-operative and post-operative fluid and sodium balance, plasma and urine elctrolyte biochemistry and their derived parameters, and circulating hormones associated with fluid balance, atrial natriureic peptide (ANP) and antidiuretic hormone (ADH) were documented to correlate with the patients' clinical conditions. Ten out of these twenty cases developed diabetes insipidus (DI) requiring ADH replacement therapy, although in the majority (6 cases), this way only a transient event. Of the nine patients who developed hyponatraemia, six had symptoms such as impaired consciousness and convulsions. Four patients developed alternating hypoatraemia and hypernatraemia, which constituted a difficult group, where appropriate sodium and fluid management, and ADH replacement therapy were based upon twice daily plasma and urine biochemistry and their derived parameters. Whilst DI in this group of patients was the result of a low circulating ADH level, hyponatraemia was not associated with an exaggerated ADH activity (6.0 +/- 2.3 vs 7.4 +/- 2.3 pmol/ml, mean +/- SEM). Rather, hyponatraemia was strongly associated with an elevated circulating ANP concentration (82.4 +/- 10.5 vs 30.0 +/- 3.1 pmol/ml, mean +/- SEM, p < 0.001), resulting in salt wasting and hypovolaemia.

Topics: Adolescent; Adult; Aged; Atrial Natriuretic Factor; Child; Creatinine; Deamino Arginine Vasopressin; Female; Humans; Hyponatremia; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Prospective Studies; Sodium; Urea; Vasopressins; Water; Water-Electrolyte Balance

Both central diabetes insipidus (DI) and a high rate of excretion of sodium (Na) and chloride (Cl) contributed to the development of polyuria and dysnatremia in two patients during the acute postoperative period after neurosurgery. To minimize difficulties in diagnosis and projections for therapy, two available (but not often used) clinical tools were helpful. First, the osmole excretion rate early on revealed the co-existence of central DI and an osmotic diuresis. The osmoles excreted were largely Na salts; after antidiuretic hormone acted, this electrolyte diuresis caused the urine flow rate to be much higher than otherwise anticipated. Interestingly, part of this saline diuresis occurred when the extracellular fluid volume was contracted. The tool to explain the basis for the dysnatremias was a tonicity balance. Hypernatremia, which developed before treatment of central DI, was primarily a result of a positive balance for Na rather than a large negative balance for water. Moreover, hyponatremia that developed once antidiuretic hormone acted was primarily a result of a negative balance for Na; the urine volume was large and its Na concentration was hypertonic. To prevent a further decline in the plasma Na concentration, either the Na concentration in the urine should be decreased by provision of urea or a loop diuretic while replacing all unwanted water and electrolyte losses; alternatively, the fluid infused should have a similar Na concentration and volume as the urine (infuse hypertonic saline).

Topics: Adult; Deamino Arginine Vasopressin; Diabetes Insipidus; Diuresis; Female; Humans; Hypernatremia; Hyponatremia; Male; Natriuresis; Osmosis; Postoperative Complications; Sodium; Vasopressins

Topics: Adolescent; Chlorides; Craniopharyngioma; Humans; Hyponatremia; Hypopituitarism; Male; Neoplasm Recurrence, Local; Pituitary Neoplasms; Postoperative Complications; Sodium; Syndrome; Vasopressins

Pleural effusions are a troublesome complication following bidirectional Glenn and Fontan procedures. It was our hypothesis that effusions may be related to alterations in hormones that regulate fluid homeostasis. We made serial determinations (by radioimmunoassay) of antidiuretic hormone, cortisol, aldosterone, angiotensin II, and renin in patients undergoing bidirectional Glenn (n = 16) and Fontan procedures (n = 24). There were six patients who developed effusions following surgery. These patients had a different endocrinological pattern characterized by persistent elevation in renin (28 +/- 9 vs 9 +/- 5 ng/mL per hour, p < 0.01) and angiotensin II (110 +/- 33 vs 33 +/- 14 ng/L, p < 0.01) on the fifth postoperative day as compared to patients who did not develop effusions. These data demonstrate that patients who develop effusions following bidirectional Glenn and Fontan procedures have activation of their renin-angiotensin system.

Topics: Adolescent; Adult; Aldosterone; Angiotensin II; Cardiac Output, Low; Cardiac Surgical Procedures; Female; Humans; Hydrocortisone; Male; Pleural Effusion; Postoperative Complications; Renin; Vasopressins

A retrospective analysis was performed to study the fluid and sodium status of patients undergoing transsphenoidal surgery (TS) for Cushing's disease. We evaluated the time of onset, duration, and relative incidence of isolated hyponatremia and identified possible factors associated with it. Of 58 patients that underwent TS over 1 yr, 52 without postoperative diabetes insipidus or volume depletion were studied. Isolated hyponatremia after TS for Cushing's disease occurred in 21%, and symptomatic hyponatremia (plasma sodium, < or = 125 mmol/L) with new onset headache, nausea, and emesis occurred in 7.0% of all operated. These later patients escaped monitoring and intervention for 24 h. The development of hyponatremia began early in the postoperative period and progressed slowly over 7 days. Maximum antidiuresis occurred on postoperative day 7. Vasopressin levels measured in two patients while hypoosmolar suggested that unregulated vasopressin release contributed to the hyponatremia. Cortisol levels, glucocorticoid replacement, and pituitary adenoma size were similar in normonatremic and hyponatremic patients. Patients combining a history of an estrogenic milieu and documented posterior pituitary trauma at surgery experienced lower nadir plasma sodium. All hyponatremic patients were fluid restricted, and none developed progressive neurological symptoms, morbidity, or mortality. We speculate that the mild degree and slow rate of development of hyponatremia and/or active monitoring and intervention contributed to the good outcome.

Topics: Adolescent; Adult; Cushing Syndrome; Female; Humans; Hyponatremia; Incidence; Male; Pituitary Gland; Postoperative Complications; Retrospective Studies; Sodium; Sphenoid Bone; Time Factors; Vasopressins

Vasopressin (VP) levels were evaluated by radioimmunoassay (RIA) in the arterial (A), peripheral (Vp) and jugular (Vj) vein blood and in CSF in 102 patients with brain tumors. In 60 cases the patients' state was complicated by brain edema (BE) and hemodynamic disturbances (HDD). The obtained data revealed significantly higher VP levels: 1) in A, Vp and CSF in patients with BE (Group A) in comparison with patients without BE (Group B), 2) in Vj in patients with HDD only (Group Bc) and 3) in Vp in patients with HDD and BE (Group Ac) in comparison with Group Bc (p < 0.05). There were marked extremely high VP levels in Vj in patients with severe haemorrhage, tachycardia and high blood pressure (BP) and in CSF in patients with tachycardia, high BP and cardiac arrest (p < 0.05 correspondingly in each of the cases). Our results on a clinical basis confirmed CSF VP influence on BE development. We also confirmed the neurohumoral (through blood) and neurotransmitter (possibly through CSF and/or vasopressinergic pathways) VP influences on cardiovascular regulation mechanisms. We content that this is a pathogenetic basis for application of VP direct or indirect antagonists for preventing and treating brain edema in neurosurgical patients.

Topics: Adolescent; Adult; Aged; Blood-Brain Barrier; Brain Edema; Brain Neoplasms; Cerebral Hemorrhage; Child; Child, Preschool; Female; Heart Arrest; Hemodynamics; Humans; Hypertension; Male; Middle Aged; Postoperative Complications; Radioimmunoassay; Synaptic Transmission; Tachycardia; Vasopressins

The study of renin-angiotensin-aldosterone (RAA) and vasopressin (VP) systems in neurosurgical patients with brain tumors and brain edema (BE) had revealed an excessive activity of these systems with secondary hyperaldosteronism especially with BE that proves the pathogenetic role of these systems. Measurement of Aldosterone (Ald) in CSF may serve as a diagnostic test to help manage the patient's clinical condition. Mechanisms of Ald penetration in CSF assumed to be the result of blood-brain-barrier (BBB) destruction (especially in astrocytomas) and/or the mediation by neuropeptides (for example increasing activity of VP V1-receptors). Results serve as a basis for application of the neuropeptide and hormone antagonists and inhibitors on all stages of cascade reactions taking part in the water and sodium retention.

Topics: Adolescent; Adult; Aged; Aldosterone; Astrocytoma; Blood-Brain Barrier; Brain Edema; Brain Neoplasms; Cerebral Hemorrhage; Child; Child, Preschool; Female; Heart Arrest; Hemodynamics; Humans; Hyperaldosteronism; Hypertension; Male; Middle Aged; Postoperative Complications; Prognosis; Radioimmunoassay; Renin-Angiotensin System; Tachycardia; Vasopressins

Topics: Adrenal Glands; Atrial Natriuretic Factor; Hemodynamics; Homeostasis; Humans; Intraoperative Complications; Postoperative Complications; Renin-Angiotensin System; Sympathetic Nervous System; Vasopressins; Water-Electrolyte Balance

To evaluate the effect of Brain Tomour (BT) and Neurosurgery (NS) on the renal handling of H2O and Na, and the clinical importance of SIADH in this setting.. Fourteen patients with BT pre-op for NS and 6 controls (C) pre-op for general surgery, were assessed in a controlled prospective trial. All patients were normovolaemic, with normal renal function. They received 400 mg of lithium carbonate (Li) 8 hours before each of two test periods (I and II) and a standard water load only before period II. Clearances studies were performed pre-op (period I) and 24 hours post-op (period II).. Serum Na was normal at all times. Despite normovolaemia, a 1% decrement in serum osmolality and the water load, ADH dramaticaly increased from time I to II mainly in the BT group (36.2 +/- 9.4 vs 7.1 +/- 0.6 pmol/L, p = 0.02). FENa, FELi and FEUricA were significantly more elevated in the BT group pre and post-op (at time II respectively 4.6 +/- 1.6 vs 1.1 +/- 0.3%; 29.3 +/- 4.9 vs 22.6 +/- 5.5; 26.0 +/- 8.1 vs 11.3 +/- 2.2, p = 0.03). Proximal and distal H2O re-absorption and distal fractional Na re-absorption were identical in both groups pre and post-operatively.. 1-BT and NS always induce a SIADH. 2-There was a primary Na loss at the proximal tubule level not explained by ADH increment, that did not significantly changed H2O handling. 3-To prevent hyponatraemia, hypotonic I.V. fluids should be avoided, but more importantly saline must be provided to this potentially salt-wasting condition.

Topics: Adult; Aged; Brain Neoplasms; Craniotomy; Female; Humans; Inappropriate ADH Syndrome; Kidney Concentrating Ability; Kidney Tubules; Lithium Carbonate; Male; Middle Aged; Postoperative Complications; Reference Values; Vasopressins; Water-Electrolyte Balance

Seventeen unselected, consecutive patients with intracranial disease and accompanying hyponatraemia were studied. All would previously have been diagnosed as having the syndrome of inappropriate antidiuretic hormone (ADH) secretion on the basis of spot plasma/urinary electrolyte testing with the application to them of existing standard laboratory criteria. Timed urinary collections and matching plasma samples were available in all but three cases for the derivation of creatinine, osmotic and free-water clearances, tubular reabsorbed water, and fractional water and sodium excretions. In a number of patients the plasma renin, aldosterone and ADH levels were also assayed. On the basis of the overall findings, 13 patients were diagnosed as in fact having a salt-wasting state whilst in only four patients was the diagnosis of inappropriate ADH secretion (SIADH) substantiated. It is suggested that obtaining simple derived parameters of sodium and water homeostasis can add significantly in differentiating between these quite opposite syndromes.

Topics: Aged; Aldosterone; Brain Diseases; Female; Homeostasis; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Postoperative Complications; Renin; Vasopressins; Water-Electrolyte Balance

Topics: Hemodynamics; Hemorrhage; Humans; Male; Middle Aged; Postoperative Complications; Shock, Septic; Vasopressins

In 17 women with refractory bleeding after myoma resection a dilute vasopressin pack was applied. Twenty units of vasopressin was diluted with 30 ml normal saline solution. A 1-inch new gauze pack was soaked in the dilute vasopressin and packed into the uteri of patients with bleeding from the beds of resected submucous myomas. The pack was left in place for no more than an hour. In none of the cases was there bleeding after the removal of the pack nor were there any side effects that could be attributed to the vasopressin.

Topics: Administration, Intravaginal; Adult; Female; Hemorrhage; Humans; Hysteroscopy; Middle Aged; Myoma; Postoperative Complications; Vasopressins

A case of pulmonary embolism associated with diabetes insipidus is reported in an 18-year-old male. The patient, who had been treated with DDAVP for diabetes insipidus and hydrocortisone for hypocorticism for two years after first operation for the removal of craniopharyngioma, was admitted with recurrence of that tumor. Diabetes insipidus immediately after second operation was controlled with intermittent drip infusion of a small amount of aqueous pitressin under monitorings of body weight hourly using a patient weighing system to keep the weight changes within +/- one kilogram. Serum and urine electrolytes levels, osmolarity, and free water clearance were also monitored every three hours to maintain water-electrolytes balances appropriately. Postoperative course had been uneventful except that CSF rhinorrhea occurred 7 days after operation. The patient was, then, kept in bed with horizontal plane to avoid further leakage of CSF. Two days later, he developed chest pain suddenly with tachypnea, tachycardia, and general cyanosis. The arterial-BGA showed PaO2 of 53.5mmHg and PaCO2 of 35.3mmHg in room air. The definite diagnosis of pulmonary embolism was made by technetium microaggregate lung perfusion scans and by pulmonary angiograms. The patient was treated with heparin, 15000IU/day, and urokinase, 720000IU/day. The symptoms due to pulmonary embolism had improved gradually within a couple of weeks. Recent articles have shown an unexpected high incidence of deep vein thrombosis and pulmonary embolism in neurosurgical patients associated with the elevation of blood coagulability. Brain tumors, especially suprasellar mass with hypothalamic dysfunction have been suggested to cause thromboembolic disorders frequently. The clinical course was described and factors causing pulmonary embolism on this patient was discussed.

Topics: Adolescent; Craniopharyngioma; Diabetes Insipidus; Heparin; Humans; Lung; Male; Neoplasm Recurrence, Local; Pituitary Neoplasms; Postoperative Complications; Pulmonary Embolism; Radionuclide Imaging; Tomography, X-Ray Computed; Urokinase-Type Plasminogen Activator; Vasopressins

We studied 13 children subjected to elective tonsillectomy, 6 of whom (study patients) received supplemental intravenous isotonic saline during and after operation, and 7 of whom (controls) did not. Clinical and biochemical evidence of hypovolaemia was present in the control but not in the study patients. Plasma antidiuretic hormone (ADH) and urine osmolality were higher in controls (p less than 0.005 and p less than 0.05 respectively). Plasma sodium concentration and osmolality were similar in the two groups. We conclude that hypovolaemia is the principal stimulus to ADH release following surgery and that, in addition to replacement of observed losses of blood and other fluids by fluids of appropriate composition, hypovolaemia should be prevented by the administration of maintenance quantities of isotonic fluid, rather than exacerbated by fluid restriction, in patients in whom oral fluid intake is interrupted for more than a brief period. Hypotonic and sodium free fluids should be avoided because of the risk of hyponatraemia.

Topics: Catecholamines; Child; Child, Preschool; Dehydration; Fluid Therapy; Humans; Hyponatremia; Isotonic Solutions; Plasma Volume; Postoperative Complications; Sodium Chloride; Surgical Procedures, Operative; Tonsillectomy; Vasopressins

In septic patients the clinical course of the disease is characterized by high DIT and rT3 serum concentrations as well as a low T3-syndrome. While rT3 is elevated in almost all critically ill patients, the increase in DIT is indicative of severe infection. Prolactin levels are regularly elevated in sepsis although to variable degrees. Catecholamines and vasopressin should be regarded as acute responders. The pattern of cortisol secretion is uncertain. In most situations the secretion appears to be elevated; the circadian rhythm is disturbed.

Topics: Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Diiodothyronines; Hormones; Humans; Hydrocortisone; Middle Aged; Postoperative Complications; Prolactin; Sepsis; Shock, Septic; Thyrotropin; Thyroxine; Triiodothyronine; Triiodothyronine, Reverse; Vasopressins

Red blood cell indices in four adolescent and preadolescent patients with documented inappropriate antidiuretic hormone secretion (SIADH) following spinal fusion were examined for evidence of dilution. The blood indices in these preoperative patients demonstrated evidence of dilution on both the intracellular and extracellular levels. The major factors causing these dilutional effects were elevated ADH, intravenous fluid overloading, and mobilization of "third space" fluids. It appears that extracellular dilution secondary to these factors results in spuriously low blood indices (namely, hemoglobin, hematocrit, and red blood cells) during the postoperative period. These findings suggest that an awareness of SIADH and avoiding intravenous fluid overloads by accurately managing intraoperative and postoperative fluids will decrease the dilutional effects observed on blood indices and perhaps save patients from unwarranted transfusions.

Topics: Adolescent; Adult; Female; Humans; Infusions, Intravenous; Male; Postoperative Complications; Spinal Fusion; Syndrome; Vasopressins

A continuous intravenous infusion of aqueous vasopressin (dosage range, 1.0 to 3.0 mU/kg/h) was administered to two patients (respective ages, 2 weeks and 3 years 1 month) who had postoperative central diabetes insipidus to determine if this mode of therapy is helpful in the very young patient. In both patients the polyuria and serum hyperosmolality were corrected. These findings suggest that an intravenous infusion of aqueous vasopressin can provide satisfactory control of the polyuria and electrolyte disturbances found in young children with acute postoperative central diabetes insipidus.

Topics: Brain; Child, Preschool; Diabetes Insipidus; Female; Humans; Infant, Newborn; Infusions, Intravenous; Male; Postoperative Complications; Vasopressins

Topics: Atrial Natriuretic Factor; Clofibrate; Craniopharyngioma; Female; Humans; Hydrocortisone; Hypernatremia; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Vasopressins

Vasopressin was used in ten critically ill patients with massive intra-abdominal bleeding unresponsive to conventional therapy. Vasopressin controlled bleeding in four patients, three of whom had continued to bleed following laparotomy for haemostasis; in two other patients, bleeding was reduced. All the patients were intensively monitored throughout the period of the vasopressin treatment; this enabled other physiological effects of vasopressin to be documented and reported. Mean arterial pressure and central venous pressure increased following the administration of vasopressin and there was a decrease in heart rate. Core body temperature rose significantly. Although all the patients had impaired renal function before receiving vasopressin, five had a prompt diuresis following its administration. Eight patients died but only three of intra-abdominal bleeding; two patients survived to leave hospital. Four patients had post-mortem evidence of ischaemia in the heart, liver and gastrointestinal tract; vasopressin may have contributed to the development of this. Vasopressin may have a place in the management of patients with life-threatening intra-abdominal haemorrhage but its use should be confined to those patients in whom conventional therapy has failed.

Topics: Abdomen; Adolescent; Adult; Female; Hemorrhage; Humans; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Time Factors; Vasopressins

Eleven patients, who had undergone renal transplantation and who had hypertension, aged 19-56 years, were treated with cyclosporine and prednisolone. We measured plasma renin activity, aldosterone and vasopressin (RIAs) at the first, second and third week and again 9 to 12 months after transplantation. Plasma renin activity was in the low-normal range throughout (0.31 +/- 0.05, 0.30 +/- 0.03, 0.32 +/- 0.05 ng/ml/h on short- vs. 0.32 +/- 0.04 ng/ml/h on long-term), aldosterone showed a tendency to decrease (114 +/- 27, 72 +/- 18, 71 +/- 11 pg/ml on short- vs. 54 +/- 23 pg/ml on long-term), whereas vasopressin remained moderately increased during the observation period (10.5 +/- 0.8, 10.4 +/- 1.6, 8.9 +/- 0.6 pg/ml on short- vs. 9.6 +/- 1.0 pg/ml on long-term). We then investigated the reactivity of the renin-system in 5 of the patients by stimulating renin release by captopril. Increases in plasma renin activity were only moderate (0.35 +/- 0.03 vs. 0.66 +/- 0.21 ng/ml/h) and blood pressure dropped only slightly (148 +/- 2.0/98 +/- 1.2 vs. 141 +/- 4.6/95 +/- 4.2 mmHg). Levels of plasma aldosterone were significantly suppressed from a low baseline (46.4 +/- 13.5 vs. 25.3 +/- 6.1 pg/ml, p less than 0.05). The increase in vasopressin was unaffected by captopril (9.6 +/- 1.0 vs. 8.8 +/- 0.4 pg/ml). Our results suggest that in renal transplantation patients with good graft function, the activity of the renin system is unaffected by cyclosporine treatment on short- and on long-term. Vasopressin stimulation does not seem to depend on the renin system and might play a role as a vasoconstrictor in the face of a denervated kidney.

Topics: Adult; Cyclosporins; Female; Humans; Hypertension; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Prednisolone; Renin-Angiotensin System; Vasopressins

The cause and treatment of early variceal bleeding in 15 patients who had undergone distal splenorenal shunt were reviewed. Eight of these patients were taken from a group of 91 who underwent selective shunts from July 1983 through June 1985 and had extensive preoperative and postoperative evaluation of shunt patency and pressure gradient. Seven patients operated upon before July 1983 were reviewed because they illustrate the cause, diagnosis, successful and unsuccessful management of bleeding after selective shunt. Urgent selective arteriography combined with shunt catheterization is the key diagnostic and therapeutic maneuver. Thrombosis of the shunt can be successfully managed by revising the anastomosis. Stenosis of the shunt can be successfully treated with balloon dilation or operative revision of the anastomosis. When renal vein hypertension (RVH) occurs, there might be inadequate decompression of the varices. A gradient of 10 millimeters of mercury or greater from left renal vein to vena cava is diagnostic. Measurements of 30 patients who had no bleeding and one patient with documented RVH show the gradient decreases over time. Treatment should be supportive until this adaptation occurs. Hemorrhage can also occur in patients with a patient shunt but without a significant pressure gradient. Inadequate decompression of the varices through the short gastric veins leading to the spleen has been proposed as one cause. Termed short gastric hypertension, this syndrome could be expected to parallel RVH because the venous collaterals will enlarge and eventually decompress the varices. Treatment should be aimed toward supporting the patient until this adaptation occurs. A small number of patients continue to bleed despite these therapeutic interventions but can sometimes be salvaged with a total shunt.

Topics: Catheterization; Dilatation; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Portasystemic Shunt, Surgical; Postoperative Complications; Reoperation; Risk; Splenorenal Shunt, Surgical; Time Factors; Vasopressins

Topics: Aged; Colonic Polyps; Female; Gastrointestinal Hemorrhage; Humans; Postoperative Complications; Vasopressins

Vasopressin infusions in normal volunteers that produce concentrations in plasma comparable to those seen during stress, cause an increase in plasma factor VIII and shortening of the euglobulin clot lysis time (ECLT). We have investigated the relationship between endogenous vasopressin (aVP) release and haemostatic function in 7 patients undergoing major abdominal surgery. Blood samples were taken at nine intervals during the operative procedure. Plasma aVP levels peaked at median values of 51 pg/ml during bowel manipulation and remained elevated on the first post-operative day. Following, and in close temporal relationship with the rise in aVP there were increases in factor VIII coagulant activity, the ristocetin co-factor, von Willebrand antigen, plasminogen activator activity (10(6)/ECLT2) and fibrinopeptide A concentrations with shortening of the activated partial thromboplastin time. The relationship was similar to that seen following infusion of aVP in human volunteers. The results are consistent with the hypothesis that aVP is an important mediator of changes in haemostatic function which accompany stress and might contribute to the thrombotic risk associated with surgical operations.

Topics: Blood Coagulation; Factor VIII; Fibrinogen; Hemostasis; Humans; Plasminogen Activators; Postoperative Complications; Thrombosis; Vasopressins

Topics: Adult; Carbon Dioxide; Female; Humans; Postoperative Complications; Pregnancy; Uterus; Vasopressins

Since 1963, a prospective evaluation of the emergency portacaval shunt procedure has been conducted in 264 unselected patients with cirrhosis and bleeding varices who underwent operation within 8 hours of admission to the emergency department. Of 153 patients who underwent operation 10 or more years ago, 45 (29 percent) have survived from 10 to 22 years and their current status is known. On admission, 40 percent of the long-term survivors had jaundice, 44 percent had ascites, 13 percent had encephalopathy (with an additional 9 percent with a history of encephalopathy), 29 percent had severe muscle wasting, and 82 percent had a hyperdynamic state. There were 9 Child's class A patients, 33 Child's class B patients, and 3 Child's class C patients. At operation, all patients had portal hypertension which was reduced by the shunt to a mean corrected free portal pressure of 18 mm saline solution. The emergency portacaval shunt procedure permanently controlled variceal bleeding. None of the patients bled again from varices, and the shunt remained patent throughout life in every patient. Encephalopathy did not affect 91 percent of the patients, but was a recurrent problem in 9 percent, usually related to the use of alcohol. Lifelong abstinence from alcohol occurred in 58 percent of the long-term survivors, but 11 percent resumed regular drinking and 31 percent consumed alcohol occasionally. Liver function declined compared with preoperative function in only 18 percent of the patients, almost always because of alcohol use. Ten years after operation, 73 percent of the patients were in excellent or good condition, and 68 percent were gainfully employed or engaged in full-time housework. Comparison of the 10 to 22 year survivors with our early group of 180 patients reported previously and our recent group of 84 patients showed no significant differences in preoperative or operative data. The single factor that appeared to influence long-term survival was resumption of regular use of alcohol. We conclude that the emergency portacaval shunt procedure, by preventing hemorrhage from varices, results in prolonged survival and an acceptable quality of life for a substantial number of patients with advanced alcoholic cirrhosis.

Topics: Adult; Aged; Alcohol Drinking; Coma; Emergencies; Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Portacaval Shunt, Surgical; Postoperative Complications; Prospective Studies; Quality of Life; Time Factors; Vasopressins

Intraarterial vasopressin infusion of the inferior mesenteric artery was used in the treatment of 2 patients with massive hemorrhage following colonoscopic polypectomy. Both patients had multiple medical problems and were considered to be very-high-risk candidates for emergency surgery. Arteriography readily demonstrated the site of bleeding, and vasopressin infusion effectively controlled the hemorrhage in both patients without complication. Angiographic management allowed elective colonic resection 1 month later in 1 patient and prevented surgery in the other who has not bled again in the 6 months following the procedure. The role of arteriography in the management of postpolypectomy hemorrhage is discussed.

Topics: Aged; Catheterization; Colonic Diseases; Colonic Polyps; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mesenteric Arteries; Postoperative Complications; Radiography; Vasopressins

In 10 patients undergoing routine coronary artery surgery, plasma renin activity and vasopressin concentration were measured at intervals before the induction of anaesthesia, and for 6 h after bypass. In three patients plasma renin activity was increased, but the increases followed no particular pattern. Vasopressin concentrations increased in all 10 patients, but the changes were not significantly correlated with the postoperative arterial hypertension that was seen in seven of the patients.

Topics: Adult; Aged; Coronary Artery Bypass; Humans; Hypertension; Intraoperative Period; Middle Aged; Postoperative Complications; Postoperative Period; Renin; Vasopressins

Polyuria subsequent to pituitary surgery was studied in 64 cases. Most cases of postoperative polyuria were due to diabetes insipidus. These cases showed a triphasic pattern in daily urinary volume. Observation of hourly urinary volume in polyuria revealed four diurnal patterns of urinary excretion: rhythmic, continuous, transient, and unspecific. Clinical observation of diurnal patterns has an advantage, in terms of simplicity of procedure, in immediately determining the nature of the polyuria, prognosticating diabetes insipidus, and eliminating inappropriate procedures in treatment. Indomethacin suppository is considered to be a favorable agent in reducing polyuria without disturbing the diurnal pattern in diabetes insipidus.

Topics: Adenoma; Adolescent; Adult; Aged; Circadian Rhythm; Diabetes Insipidus; Female; Humans; Indomethacin; Male; Middle Aged; Pituitary Diseases; Pituitary Neoplasms; Polyuria; Postoperative Complications; Sodium; Vasopressins

Perioperative plasma antidiuretic hormone (vasopressin) levels were determined in 8 patients undergoing radical cystectomy. Marked elevations of antidiuretic hormone were noted immediately postoperatively in all patients and these levels persisted for 48 hours. Plasma antidiuretic hormone was elevated beyond the physiological levels needed for maintenance of intravascular volume and osmolarity. Excessive antidiuretic hormone secretion is common after radical cystectomy and should be considered in the differential diagnosis of postoperative oliguria in these patients.

Topics: Aged; Diagnosis, Differential; Female; Furosemide; Humans; Ileum; Male; Middle Aged; Oliguria; Osmolar Concentration; Postoperative Complications; Postoperative Period; Time Factors; Urinary Bladder; Urinary Diversion; Vasopressins

The current state of endoscopic polypectomy of the large intestine is analysed. The indications for this treatment and the main complications arising (haemorrhages, perforations, colonic rupture) are evaluated with details of possible treatment and/or prevention. The connections with histology and surgery are also discussed. Finally, the treatment and follow-up of cancerised rectocolonic polyps are discussed in detail.

Topics: Arginine Vasopressin; Electrocoagulation; Epinephrine; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Intestinal Perforation; Intestinal Polyps; Intestine, Large; Laser Therapy; Postoperative Complications; Rupture; Vasopressins

Topics: Adult; Aged; Catheterization; Embolization, Therapeutic; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Middle Aged; Neoplasms; Postoperative Complications; Vasopressins

Topics: Adolescent; Adult; Child; Child, Preschool; Craniopharyngioma; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Hydrocortisone; Male; Pituitary Neoplasms; Postoperative Complications; Vasopressins

The authors' experience in the management of postoperative vaginal hemorrhage from 1975 to 1980 was reviewed. Recently, success has been achieved using angiographic arterial embolization with the Gianturco minicoil. The results of embolization are compared with those achieved through other more conventional methods. The authors have found angiographic embolization to be safe, simple, and effective, and they recommend that the procedure be performed before laparotomy for intractable postoperative vaginal bleeding.

Topics: Adult; Angioplasty, Balloon; Embolization, Therapeutic; Female; Femoral Artery; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Uterine Hemorrhage; Vasopressins

Three cases of transient central diabetes insipidus after cardiopulmonary bypass are presented. All 3 patients responded promptly to administration of vasopressin, and were completely recovered from polyuria 10 days after cardiac surgery. It is postulated that transient diabetes insipidus after cardiac operation occurred in some patients who had preexisting selective osmoreceptor dysfunction when cardiac standstill during extracorporeal circulation alters the left atrial nonosmotic receptor function, resulting in suppression of antidiuretic hormone release.

Topics: Arginine Vasopressin; Coronary Artery Bypass; Diabetes Insipidus; Diuresis; Humans; Male; Postoperative Complications; Time Factors; Vasopressins

ADH imbalance may occur in patients after pituitary surgery. Two cases are presented that demonstrate the problems associated with the disturbance of water metabolism. The medical management of these patients is discussed, with emphasis on the importance of the correct choice of pharmacological agents to control the manifestations of ADH imbalance.

Topics: Aged; Carbamazepine; Chlorpropamide; Clofibrate; Diuretics; Female; Fluid Therapy; Humans; Hypophysectomy; Inappropriate ADH Syndrome; Male; Pituitary Gland; Postoperative Complications; Time Factors; Vasopressins; Water-Electrolyte Balance

Topics: Breast Neoplasms; Diabetes Insipidus; Female; Humans; Hypophysectomy; Pituitary Gland; Postoperative Complications; Vasopressins

Topics: Acute Disease; Adenoma; Adult; Body Weight; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Pituitary Neoplasms; Postoperative Complications; Solubility; Vasopressins

Topics: Adolescent; Adult; Craniopharyngioma; Diabetes Mellitus; Humans; Pituitary Neoplasms; Postoperative Complications; Vasopressins

Topics: Adult; Angiography; Arteries; Female; Humans; Infusions, Intra-Arterial; Ligation; Postoperative Complications; Postpartum Hemorrhage; Pregnancy; Vasopressins

Most patients with upper gastrointestinal hemorrhage from Mallory-Weiss tear cease bleeding spontaneously and do not require specific therapy. Patients who either continue to bleed and those who rebleed represent specific therapeutic problems. Angiotherapy, either intraarterial vasopressin infusion (13 cases) or arterial embolization (two cases), was used to treat 15 patients with persistently bleeding Mallory-Weiss tears. Permanent hemostasis was achieved in the majority of patients treated. Results from the current study are compared with those previously reported in the literature. In addition the complications of each treatment method are discussed with emphasis on the cardiac complications of vasopressin.

Topics: Adolescent; Adult; Aged; Embolization, Therapeutic; Female; Gastrointestinal Hemorrhage; Humans; Infusions, Intra-Arterial; Male; Mallory-Weiss Syndrome; Middle Aged; Myocardial Infarction; Postoperative Complications; Retrospective Studies; Vasopressins

Medullary thyroid carcinoma (MTC) is a known apudoma producing calcitonin, prostaglandins and serotonin. It can present itself as a familial or sporadic form or as part of a multiple endocrine adenomatosis. We present here the case of a patient admitted with a four-year history of diarrhea, enlargement of the thyroid and palpable lymph nodes in the right side of the neck. There was no uptake of 131I in the right lobe of the thyroid and the serum calcitonin levels were very high. With the diagnosis of MTC a total thyroidectomy mas performed developping within hours of the surgical procedure a picture of diabetes insipidus with 31 liters of urine output in the first 48 hours. It responded to vasopressin and disappeared spontaneously in two weeks. We have considered the different mechanisms that could explain the development of diabetes insipidus, and after failing to find one, we especulate at prostaglandins could play an important role in the synthesis and/or release of ADH. The sudden depletion of prostaglandins after removal of the neoplasm that produced them could account for the diabetes insipidus in our patient. We have not found any similar case described in the literature. We call attention to the need for a close postoperative observation of patients operated for MTC for the possible onset of diabetes insipidus.

Topics: Adult; Apudoma; Diabetes Insipidus; Humans; Male; Postoperative Complications; Thyroid Neoplasms; Thyroidectomy; Vasopressins

Topics: Blood Glucose; Child; Child, Preschool; Craniopharyngioma; Diabetes Insipidus; Diabetic Coma; Female; Humans; Hyperglycemic Hyperosmolar Nonketotic Coma; Pituitary Neoplasms; Postoperative Complications; Vasopressins

Topics: Adult; Cecal Diseases; Cytomegalovirus Infections; Female; Gastrointestinal Hemorrhage; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Transplantation, Homologous; Ulcer; Vasopressins

Topics: Clofibrate; Craniopharyngioma; Diabetes Insipidus; Drinking; Humans; Neoplasm Recurrence, Local; Pituitary Neoplasms; Postoperative Complications; Sodium; Vasopressins

Topics: Creatinine; Glomerular Filtration Rate; Growth Hormone; Humans; Inappropriate ADH Syndrome; Neurophysins; Pituitary Gland, Posterior; Postoperative Complications; Potassium; Sella Turcica; Sodium; Vasopressins; Water-Electrolyte Balance

A 49-year-old man was submitted to neurosurgery for a cranio-pharyngioma. The lesion, which appeared to involve the antero-inferior wall of the third ventricle, caused lack of appropriate antidiuretic hormone (ADH) release in response to hypernatraemia and plasma hyperosmolality. The probable mechanism of this hypothalamic syndrome is suggested.

Topics: Craniopharyngioma; Humans; Hypernatremia; Hypothalamus; Male; Middle Aged; Osmolar Concentration; Pituitary Neoplasms; Postoperative Complications; Potassium; Sodium; Vasopressins

Topics: Angiography; Embolization, Therapeutic; Endoscopy; Gastrointestinal Hemorrhage; Humans; Hydrogen-Ion Concentration; Peptic Ulcer Hemorrhage; Postoperative Complications; Stomach Ulcer; Stress, Physiological; Vasopressins

In acute gastrointestinal bleeding visceral angiography has been showing its importance for years. It contributes to diagnosis especially in cases with persistent acute hemorrhage. In chronic gastrointestinal bleeding conventional radiographic procedures such as upper gastrointestinal series and barium enema will be preferred to angiography. The function of the radiologist goes beyond mere diagnosis of gastrointestinal bleeding. Treatment with vasopressin via the angiographic catheter has proven its clinical value. This method will be indicated especially in cases with high risk anesthesia and surgery. It will help to postpone necessary surgery to a more favorable moment following hemostasis. Side effects such as hypertension and antidiuresis are relatively rare and easy to manage. Numerous substances are used for embolization showing that ideal material has not been found yet and further development seems necessary. In contrast to vasopressin treatment, vascular occlusion is often irreversible, complications (unwanted reflux of embolization material, necrosis and plugging of the catheter) are more difficult to manage. Superselective visualization of a bleeding artery is always needed. Embolization is justified in cases when a possibility for anesthesia and surgery cannot be foreseen. The electrical vascular occlusion using direct current is still in the phase of animal experiments; its clinical value has not sufficiently been assessed as yet.

Topics: Aneurysm; Angiography; Duodenal Diseases; Embolization, Therapeutic; Enteritis; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Male; Peptic Ulcer; Peutz-Jeghers Syndrome; Postoperative Complications; Salmonella Infections; Vasopressins

Catheter dislodgement is a major cause of technical failures in intraarterial vasopressin therapy for gastrointestinal bleeding. Ten such cases were observed in the past five years. In seven patients catheter dislodgement led to recurrent bleeding during vasopressin infusion. In one patient aortic infusion of vasopressin caused recurrent bleeding and reversible acrocyanosis of the feet, and in two patients vasopressin infusion into the left renal artery resulted in chest pain and hematuria. Catheter dislodgement should be suspected if bleeding that was initially controlled recurs during vasopressin infusion.

Topics: Adolescent; Angiography; Aorta, Abdominal; Catheterization; Celiac Artery; Female; Gastrointestinal Hemorrhage; Heart Valve Prosthesis; Humans; Infusions, Parenteral; Male; Middle Aged; Peptic Ulcer Hemorrhage; Postoperative Complications; Spinal Injuries; Vascular Diseases; Vasopressins

We used dDAVP, the 1-desamino-8-D arginine analogue of arginine vasopressin with high antidiuretic and low vasopressor potency, to treat 29 patients with neurogenic diabetes insipidus for up to 22 months. Intranasal dDAVP, 2.5 to 15 microgram twice daily, provided excellent control in most patients. Individual responses were independent of age, weight, and severity of diabetes insipidus. Resistance to dDAVP may be a rare complication of prolonged therapy. Two patients with acute postoperative diabetes insipidus were effectively treated with 5 microgram of dDAVP every 14 to 18 h. Compared to previous therapy, side effects of dDAVP were minimal (headaches in two patients), and control of symptoms and urine volume was as good as with vasopressin tannate in oil or better than chlorpropamide and lysine vasopressin nasal spray. We conclude that intranasal dDAVP, because of efficacy, long duration of action, and infrequent side effects, is the preferred treatment of neurogenic diabetes insipidus in children and adults.

Topics: Adolescent; Adult; Aged; Arginine Vasopressin; Child; Diabetes Insipidus; Female; Humans; Male; Middle Aged; Nervous System Diseases; Osmolar Concentration; Postoperative Complications; Vasopressins

Rational intraoperative fluid therapy is based on an understanding of the pathophysiology of severe trauma and surgery. Fluids of suitable compositions are administered in sufficient quantities to form part of the daily maintenance requirement and also to replace blood and ECF lost during surgery.

Topics: Acute Kidney Injury; Adrenal Cortex Hormones; Blood Transfusion; Extracellular Space; Humans; Infusions, Parenteral; Kallikreins; Kidney; Oliguria; Postoperative Complications; Renin; Shock; Sodium; Surgical Procedures, Operative; Vasopressins; Water-Electrolyte Balance

The importance and differential diagnosis of postoperative oliguria are discussed. A plea is made for the recognition of undesired postoperative antidiuretic hormone (ADH) secretion as a separate entity in the aetiology of postoperative oliguria. Five patients are described who suffered from postoperative oliguria and in whom the diagnosis of undesired ADH secretion was made. The successful treatment of this condition with diphenylhydantoin is emphasized.

Topics: Adult; Aged; Anuria; Diagnosis, Differential; Furosemide; Humans; Middle Aged; Oliguria; Osmolar Concentration; Postoperative Complications; Vasopressins

The cases of diabetes insipidus (DI) after surgery of intracranial aneurysms were reported and discussed. 1. Of 112 patients operated on for intracranial arterial aneurysm (microsurgical approach), four patients (3.6%) showed DI in the postoperative period. In 3 cases of these 4, the aneurysms located on the anterior communicating artery and the remaining one was the posterior inferior cerebellar artery. 2. The exact mechanism of occurrence of DI is obscure. We suppose that not only vascular spasm of branches of the anterior cerebral and anterior communicating arteries supplying to the paraventricular and preoptic nucleus, but also surgical trauma with direct tissue injury might explain the symptoms. 3. All patients showed a monophasic type of DI which started 1 to 4 days after surgery and lasted from 6 up to 9 days. 4. Two patients with DI showed decreased plasma ADH values below 0.6 microunits/ml in the few days prior to the appearance of abnormally large amount of urinary output. Therefore, once the diagnosis of postoperative DI is made, the patients should be managed promptly with the replacement therapy of Aqueous pitressin. 5. A slow continuous infusion of Aqueous pitressin in the range of 1 to 1.5 IU/hr effectively reduce the polyuria which were not controlled by intermittent intramuscular injections.

Topics: Adult; Aged; Aldosterone; Diabetes Insipidus; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Postoperative Complications; Radioimmunoassay; Vasopressins

Topics: Child; Craniopharyngioma; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Infant; Male; Pituitary Neoplasms; Postoperative Care; Postoperative Complications; Sodium; Time Factors; Vasopressins; Water-Electrolyte Imbalance

1-Deamino-8-d-arginine vasopressin (D.D.A.V.P.) infusion causes a marked increase in factor-VIII (antihaemophilic-factor)-related properties in patients with moderate and mild haemophilia and von Willebrand's disease (vWd). The possibility was therefore evaluated that such an autologous factor-VII response might be haemostatically effective, allowing patients to undergo surgery without plasma concentrates. 0.3 microng/kg of D.D.A.V.P. given before dental surgery and repeated in the early postoperative period was followed by a two to three fold rise in factor-VIII coagulant activity (VII C.A.) in four patients with moderate and mild haemophilia. In two, there was no abnormal bleeding after dental extraction, whereas plasma concentrates were necessary to control oozing from the sockets in the remaining two patients. A higher D.D.A.V.P. dosage (0.4-0.5 microng/kg) in patients with higherstarting VII C.A. (9% or more) was followed by a more marked response (four to six fold). VII C.A. levels up to 100% of average normal were achieved and dental extraction and major surgery (such as cholecystectomy, thoracotomy, and two tonsillectomies) were carried out successfullly in six patients with mild haemophilis and in two with vWd. The mean half-life of autologous VII C.A. was 9.4 h (range 7.5-11.6). Plasma and urine osmolality showed no consistent variation after drug administration. Thus D.D.A.V.P. appears a promision pharmacological alternative to plasma concentrates in the management of some patients with haemophilis and vWd.

Topics: Adolescent; Adult; Biopsy; Blood Coagulation Tests; Cholecystectomy; Deamino Arginine Vasopressin; Drug Evaluation; Factor VIII; Female; Hemophilia A; Hemorrhage; Hemostasis, Surgical; Humans; Infusions, Parenteral; Male; Middle Aged; Postoperative Care; Postoperative Complications; Preoperative Care; Thoracic Surgery; Thorax; Tonsillectomy; Tooth Extraction; Vasopressins; von Willebrand Diseases

Topics: Arginine Vasopressin; Drug Evaluation; Female; Hemophilia A; Hemorrhage; Hemostasis, Surgical; Hemostatics; Humans; Postoperative Care; Postoperative Complications; Preoperative Care; Vasopressins; von Willebrand Diseases

Topics: Aged; Female; Humans; Infant; Middle Aged; Polyuria; Postoperative Complications; Vasopressins

Topics: Animals; Antacids; Burns; Central Nervous System Diseases; Humans; Peptic Ulcer; Postoperative Complications; Stomach Ulcer; Stress, Physiological; Vasopressins; Wounds and Injuries

Clinical aspects with disturbances in fluid and electrolytes metabolism in brain diseases were discussed reviewing 41 cases experienced in our department. These 41 cases were found in 377 patients with diseases of the central nervous system in our hospital during recent 14 months. Hyponatremia was found in 19 cases and aneurysms of A-C, A1 and A2 had the majority of the cases. The cerebral angiography suggested an unstable blood supply to the anterior portion of the hypothalamus, for instance, showing remarkable shift, spasm or obstruction A-C, A1 or A2. The duration of hyponatremia was transient and mostly less than 2 weeks after the last attack of subarachnoid hemorrhage. On the contrary, hypernatremia was seen in 9 cases and 6 of them were found in cases of tumors in the pineal region and A-C, A1 and A2 were intact angiographically. The hypernatremia was continuous and did not response to V-P shunt or any kinds of infusion therapy. The hypernatremia due to cerebral disease is thought to be a result of destruction of the supraoptic and paraventricular nuclei or adjacent area in the anterior potion of the hypothalamus in most of presumed these cases. It might be that the decreased blood supply to the anterior position of the hypothalamus offers an information not of hypoosmolarity but of hypovolemic state, and this information increases the secretion of ADH. This mechanism of hyponatremia could play an important role in S.I.A.D.H.

Topics: Adolescent; Adult; Aged; Brain Diseases; Brain Neoplasms; Child; Female; Humans; Hypernatremia; Hyponatremia; Infant; Intracranial Aneurysm; Male; Middle Aged; Pinealoma; Postoperative Complications; Vasopressins

Topics: Colonic Neoplasms; Female; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Intestinal Polyps; Mesenteric Arteries; Middle Aged; Postoperative Complications; Radiography; Vasopressins

During the past decade the diagnostic use of blood volume determinations has declined as a result of the generation of largely inaccurate results and inappropriate normalization and interpretation. After historical development of more than 50 years, current methodology employs 125I-labeled human serum albumin and 51Cr-labeled red blood cells to determine plasma volume and red cell volume, respectively. Accurate blood volume determinations require (1) abandoning the use of the mean body hematocrit:venous hematocrit ratio and using simultaneous independent measurements of both volumes; (2) delaying multiple postinjection patient samples until complete mixing and equilibration are complete; (3) backextrapolation of plasma concentrations of 125I to account for albumin loss from the plasma, and, rarely, back-extrapolation of red cell concentrations to account for dilution by red cells transfused during the procedure; (4) normalization of volumes by adjusting patient weight to normal correspondence with lean tissue mass, whenever necessary. A rapid, routine method that fulfills these four requirements is presented. A number of surgical and medical conditions in which blood volume determinations are very useful in diagnosis and therapy are discussed. Recently developed techniques for blood volume measurements include neutron acativation analysis and fluorescent excitation analysis. Correct normalization of accurate blood volume measurements will provide a valuable service to the entire medical community.

Topics: Aged; Blood Volume Determination; Body Constitution; Carbon Monoxide; Central Venous Pressure; Chromium Radioisotopes; Diagnostic Errors; Erythrocytes; Hematocrit; Hormones, Ectopic; Humans; Hyperaldosteronism; Hypertension; Indium; Iron Radioisotopes; Male; Phosphorus Radioisotopes; Plasma Volume; Polycythemia; Postoperative Complications; Potassium Radioisotopes; Radioisotope Dilution Technique; Serum Albumin, Radio-Iodinated; Shock; Technetium; Time Factors; Transferrin; Vasopressins

Topics: Brain Abscess; Brain Injuries; Enterococcus faecalis; Follow-Up Studies; Humans; Male; Meningitis; Military Medicine; Postoperative Complications; Prospective Studies; Pulmonary Embolism; Staphylococcal Infections; Streptococcal Infections; Surgical Wound Dehiscence; Surgical Wound Infection; Transportation of Patients; United States; Vasopressins; Vietnam; Warfare; Wounds, Gunshot

Topics: 17-Hydroxycorticosteroids; Acetylcholine; Adrenocorticotropic Hormone; Albuminuria; Aldosterone; Growth Hormone; Histamine; Humans; Hydrocortisone; Insulin; Neurons, Afferent; Oxygen Consumption; Postoperative Complications; Renin; Serotonin; Testosterone; Thyroid Hormones; Vasopressins; Wounds and Injuries

Topics: Acute Disease; Anuria; Child; Craniopharyngioma; Depression, Chemical; Diabetes Insipidus; Female; Humans; Injections, Intravenous; Phenytoin; Pituitary Neoplasms; Postoperative Care; Postoperative Complications; Secretory Rate; Sodium; Stimulation, Chemical; Time Factors; Vasopressins

Topics: Animals; Blood Pressure; Cardiac Output; Dogs; Drug Synergism; Drug Therapy, Combination; Hepatectomy; Hypertension, Portal; Infusions, Parenteral; Isoproterenol; Liver Circulation; Portal Vein; Postoperative Care; Postoperative Complications; Preoperative Care; Vasopressins

Topics: Adult; Angiography; Arteries; Blood Transfusion; Catheterization; Esophageal and Gastric Varices; Gastritis; Gastrointestinal Hemorrhage; Gelatin Sponge, Absorbable; Hemostasis; Humans; Ileum; Jejunum; Male; Peptic Ulcer Hemorrhage; Postoperative Complications; Stomach; Vasopressins

Topics: Aldosterone; Blood Transfusion; Humans; Kidney; Nutritional Physiological Phenomena; Parenteral Nutrition; Postoperative Care; Postoperative Complications; Vasopressins; Water-Electrolyte Balance

Topics: Age Factors; Blood Transfusion; Endoscopy; Esophageal and Gastric Varices; Fiber Optic Technology; Gastrointestinal Hemorrhage; Humans; Intubation, Gastrointestinal; Liver Cirrhosis; Melena; Neurologic Manifestations; Postoperative Complications; Radiography; Retrospective Studies; Vasopressins

Topics: Anesthesia, Inhalation; Blood Urea Nitrogen; Body Weight; Creatinine; Drug Synergism; Fluorides; Gentamicins; Humans; Kidney Diseases; Male; Methoxyflurane; Middle Aged; Osmolar Concentration; Postoperative Complications; Uric Acid; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Aged; Biopsy; Cervix Uteri; Female; Humans; Methods; Middle Aged; Postoperative Complications; Pregnancy; Uterine Cervical Neoplasms; Uterine Hemorrhage; Vasopressins

Topics: Adolescent; Diabetes Insipidus; Diuretics; Female; Humans; Hydrochlorothiazide; Hydronephrosis; Hypertrophy; Infant; Kidney Diseases; Male; Postoperative Complications; Sodium; Ureteral Obstruction; Ureterocele; Urinary Bladder Diseases; Urography; Vasopressins; Water

Topics: Aged; Drug Combinations; Female; Hemorrhage; Hemostasis; Humans; Male; Middle Aged; Ornithine; Postoperative Complications; Prostatectomy; Prostatic Hyperplasia; Tyrosine; Urinary Bladder; Urinary Bladder Neoplasms; Urologic Diseases; Vasopressins

Topics: 17-Hydroxycorticosteroids; Adolescent; Adrenal Gland Neoplasms; Adrenal Glands; Adrenal Insufficiency; Adrenalectomy; Adrenocorticotropic Hormone; Adult; Child; Cortisone; Cushing Syndrome; Female; Humans; Hydrocortisone; Hypothalamus; Male; Metyrapone; Middle Aged; Pituitary Gland; Pituitary-Adrenal Function Tests; Postoperative Complications; Prednisone; Stress, Physiological; Time Factors; Vasopressins

Topics: Adult; Aged; Female; Hemorrhage; Humans; Hysterectomy; Middle Aged; Postoperative Complications; Regional Blood Flow; Time Factors; Uterine Prolapse; Uterus; Vasopressins

Topics: Acid-Base Equilibrium; Blood Cell Count; Cortisone; Depression; Diabetes Insipidus; Diuresis; Electrocardiography; Heart Failure; Hemorrhage; Humans; Hypophysectomy; Kidney Diseases; Methods; Pituitary Diseases; Pituitary Neoplasms; Postoperative Care; Postoperative Complications; Posture; Preoperative Care; Sodium; Time Factors; Vasopressins

Topics: Brain Edema; Carotid Artery Diseases; Cerebral Arterial Diseases; Circle of Willis; Dexamethasone; Diabetes Insipidus; Humans; Intracranial Aneurysm; Postoperative Complications; Potassium; Sodium; Thirst; Trimethaphan; Vasopressins; Water-Electrolyte Balance

Topics: Adult; Analgesia; Anesthesia, General; Anesthetics, Local; Blood Pressure; Brain Diseases; Brain Neoplasms; Craniotomy; Epinephrine; Female; Hemorrhage; Hemostasis; Humans; Male; Middle Aged; Ornithine; Pallor; Parkinson Disease; Postoperative Complications; Pulse; Stereotaxic Techniques; Trephining; Vasoconstrictor Agents; Vasopressins; Wound Healing

Topics: Adult; Aged; Alcoholism; Blood Transfusion; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Male; Middle Aged; Portacaval Shunt, Surgical; Postoperative Complications; Tampons, Surgical; Therapeutic Irrigation; Time Factors; Vasopressins

Topics: Brain; Brain Edema; Craniocerebral Trauma; Craniotomy; Humans; Hyponatremia; Natriuresis; Nutrition Disorders; Osmolar Concentration; Pituitary Gland; Postoperative Complications; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Abortion, Criminal; Abortion, Legal; Adult; Amniocentesis; Amnion; Amniotic Fluid; Female; Humans; Hydatidiform Mole; Hypernatremia; Hypertonic Solutions; Intestinal Perforation; Maternal Mortality; Oxytocin; Postoperative Complications; Potassium; Pregnancy; Punctures; Sodium; Surgical Wound Infection; Uterine Hemorrhage; Uterine Rupture; Vasopressins; Water-Electrolyte Balance

Topics: Blood; Dehydration; Homeostasis; Humans; Osmolar Concentration; Osmotic Pressure; Postoperative Complications; Surgical Procedures, Operative; Urine; Vasopressins; Water Intoxication; Water-Electrolyte Balance

Topics: Blood Pressure; Blood Vessels; Diarrhea; Female; Hemorrhage; Humans; Male; Ornithine; Pallor; Postoperative Complications; Skin; Surgical Procedures, Operative; Time Factors; Vasoconstrictor Agents; Vasopressins

Topics: Adolescent; Adult; Aged; Anesthesia, Inhalation; Blood Urea Nitrogen; Creatinine; Diuresis; Female; Humans; Kidney; Kidney Function Tests; Male; Methoxyflurane; Middle Aged; Obesity; Osmolar Concentration; Postoperative Complications; Sodium; Succinylcholine; Thiopental; Urine; Vasopressins; Water-Electrolyte Balance

Topics: Adolescent; Diabetes Insipidus; Female; Heart Septal Defects, Ventricular; Humans; Osmolar Concentration; Postoperative Complications; Vasopressins; Water Deprivation

Topics: Adult; Cardiac Surgical Procedures; Female; Heart Septal Defects; Humans; Hypotension; Hypothalamus; Mitral Valve Stenosis; Polyuria; Postoperative Complications; Vasopressins

Topics: Acetates; Acute Disease; Adult; Chlorides; Coma; Cortisone; Craniopharyngioma; Diabetes Insipidus; Diet Therapy; Electrocardiography; Humans; Hypernatremia; Hypokalemia; Male; Natriuresis; Osmolar Concentration; Paralysis; Pituitary Neoplasms; Postoperative Complications; Potassium; Sodium; Thirst; Thyroxine; Vasopressins

Topics: Blood Transfusion; Cardia; Esophageal and Gastric Varices; Gastrectomy; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Methods; Postoperative Complications; Stomach; Vasopressins

Topics: Breast Neoplasms; Cortisone; Desoxycorticosterone; Diabetes Insipidus; Female; Hematocrit; Humans; Hyponatremia; Hypothalamo-Hypophyseal System; Middle Aged; Neoplasm Metastasis; Nerve Degeneration; Nerve Regeneration; Neurons; Pituitary Gland; Pituitary Gland, Posterior; Postoperative Complications; Sodium; Sodium Chloride; Vasopressins; Water; Water-Electrolyte Balance

Topics: Adolescent; Adult; Aged; Blood Pressure; Child; Child, Preschool; Felypressin; Female; Humans; Hypotension; Male; Middle Aged; Postoperative Complications; Vasopressins

Topics: Adolescent; Adrenocorticotropic Hormone; Blood Glucose; Body Height; Body Weight; Brain Neoplasms; Child; Craniopharyngioma; Exercise Test; Feeding and Eating Disorders; Female; Glucose Tolerance Test; Gonadotropins; Growth; Growth Hormone; Humans; Hypothalamus; Insulin; Male; Obesity; Pituitary Neoplasms; Postoperative Complications; Radioimmunoassay; Thirst; Thyrotropin; Vasopressins; Vision Disorders

Topics: Adolescent; Adult; Aged; Alcoholism; Child; Emergencies; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypertension, Portal; Liver Cirrhosis; Liver Function Tests; Male; Middle Aged; Portacaval Shunt, Surgical; Postoperative Complications; Vasopressins

Topics: Epinephrine; Felypressin; Female; Hemorrhage; Humans; Hysterectomy; Ornithine; Oxytocin; Phenylalanine; Postoperative Complications; Vagina; Vasopressins

1. Indirect evidence suggests that the concentration of arginine vasopressin in the plasma of normally hydrated man is about 1 mu-u./ml., but this is usually considered to be below the limit of sensitivity of the standard assay preparation, the water-loaded Wistar rat under ethanol anaesthesia.2. It was found that there was a surprising variation in sensitivity to vasopressin between batches of Wistar rats, and that other varieties of rat (including those with diabetes insipidus) were no more sensitive.3. Three modifications of the standard assay procedure produced an increase in sensitivity:(a) using Wistar rats weighing 100-150 g, rather than larger animals;(b) commencing the assay shortly after surgery, i.e. as soon as the urine flow reached 25 mul./min;(c) infusing vasopressin intravenously (0.5-3 mu-u./min). By using modification (a) with either (b) or (c) it was possible to detect as little as 0.5 mu-u.4. With these modifications antidiuretic activity equivalent to 0.5-2.0 mu-u./ml. of arginine vasopressin was measured in nine samples of plasma from a normally hydrated subject.5. It is suggested that the frequent reports of enhanced sensitivity may have been due to the fortuitous use of a particularly sensitive batch of rats, or to a high endogenous secretion of vasopressin due to operative trauma.

Topics: Animals; Arginine; Biological Assay; Diabetes Insipidus; Diuresis; Female; Postoperative Complications; Rats; Species Specificity; Vasopressins

Topics: Dextrans; Edema; Fallopian Tubes; Felypressin; Female; Humans; Isotonic Solutions; Peritoneal Neoplasms; Postoperative Complications; Pregnancy; Pregnancy, Tubal; Sterilization, Reproductive; Therapeutic Irrigation; Tissue Adhesions; Vasopressins

Topics: Adult; Body Weight; Diabetic Retinopathy; Epilepsy, Tonic-Clonic; Female; Humans; Hyponatremia; Male; Middle Aged; Palliative Care; Pituitary Gland; Postoperative Complications; Tremor; Vasopressins

Topics: Adult; Diabetes Insipidus; Humans; Hypopituitarism; Male; Postoperative Complications; Sodium; Vasopressins; Water-Electrolyte Balance

Topics: Female; Hemorrhage; Hemostasis; Humans; Male; Postoperative Complications; Prostatectomy; Urethra; Urinary Bladder Diseases; Urinary Bladder Neoplasms; Vasopressins

Topics: Angiotensins; Blood Pressure Determination; Central Nervous System Stimulants; Heart Arrest; Heart Failure; Humans; Hypotension; Pharmacology; Postoperative Care; Postoperative Complications; Shock; Sympathomimetics; Toxicology; Vascular Diseases; Vasopressins; Water-Electrolyte Balance

Topics: Blood Chemical Analysis; Digestive System Surgical Procedures; Disease Susceptibility; Edema; Gastrectomy; Humans; Liver; Postoperative Complications; Stomach; Vasopressins

Topics: Adrenal Cortex Hormones; Adrenal Gland Diseases; Adrenal Glands; Adrenocorticotropic Hormone; Animals; Atrophy; Hypertrophy; Hypophysectomy; Kidney; Liver; Pituitary-Adrenal Function Tests; Postoperative Complications; Rats; Stomach; Thymus Gland; Vasopressins