pituitrin and Scoliosis

Patients undergoing surgery for idiopathic scoliosis were studied to determine the incidence and aetiology of oliguria during the perioperative period and to evaluate the efficacy of low dose dopamine in preventing its occurrence. Thirty patients, aged 6-18 years undergoing elective surgery were studied. Anaesthesia was standardized. Patients were randomized to receive either dopamine infusion (3 micrograms.kg-1.min-1) (Group A) (n = 15) or dextrose infusion (control) (Group B) (n = 15). Serum and urinary electrolytes and osmolalities and serum antidiuretic hormone (ADH) concentrations were measured. Urine output and haemodynamic parameters were recorded. Intraoperative oliguria occurred in 7% of patients in Group A and 47% in Group B (P < 0.05). Postoperative oliguria occurred in 20% of patients in Group A and 47% in Group B (P > 0.05). Urine and serum biochemical analysis revealed a statistically significant decrease in serum sodium and osmolality (P < 0.005) and an increase in urinary sodium and osmolality in both groups. Serum ADH concentrations were increased in both groups (P < 0.05), returning to baseline 18 h postoperatively. We conclude that oliguria during corrective spinal surgery occurs in association with excess ADH secretion as opposed to perioperative hypovolaemia. Dopamine increases urine output in the perioperative period but does not prevent the release of ADH and its subsequent biochemical effects.

Topics: Adolescent; Anesthesia, Inhalation; Cardiac Output; Central Venous Pressure; Child; Diuresis; Dopamine; Female; Humans; Intraoperative Complications; Male; Oliguria; Osmolar Concentration; Postoperative Period; Scoliosis; Sodium; Spine; Vasopressins

This study was undertaken to investigate the role played by antidiuretic hormone (ADH), the renin-angiotensin system and atrial natriuretic factor (ANF) in the oliguria in patients undergoing spinal fusion.. Sixteen patients undergoing posterior spinal fusion using isoflurane and fentanyl (n = 8) or sufentanil (n = 8) had renin, aldosterone, ADH and ANF measurements.. Compared to the non-oliguric patients, the oliguric patients had a higher number of fused vertebrae 10.5 +/- 1.3 vs. 9.0 +/- 0.5 (P = 0.01) and higher renin values at 12h (3.3 +/- 3.2 vs. 0.7 +/- 0.6 ng L(-1) s(-1), P = 0.04). Hormonal values that had a significant correlation with intraoperative diuresis were: renin at 0.5 h (r2 = 0.26, P = 0.04), aldosterone at 0.5 h (r2 = 0.30, P = 0.03) and ANF at 0.5 h (r2 = 0.32, P = 0.02). Those that had a significant correlation with the mean postoperative diuresis were: renin at 6 h (r2 = 0.29, P = 0.03), 8h (r2 = 0.26, P = 0.04) and 12h (r2 = 0.31, P = 0.03), aldosterone at 6h (r2 = 0.54, P = 0.001), 8h (r2 = 0.40, P = 0.01) and 12h (r2 = 0.32, P = 0.03), ADH at 24h (r2 = 0.38, P = 0.01) and ANF at 6h (r2 = 0.26, P = 0.045). Using stepwise regression, excluding hormonal values, only two continuous variables had a significant correlation with the mean postoperative diuresis: the number of fused vertebrae (P = 0.02) and the length of surgery (P = 0.02).. Activation of the renin-angiotensin system is the major cause of the early intraoperative oliguria. ADH and the renin-angiotensin system are both involved in the pathophysiology of postoperative oliguria in patients undergoing spinal fusion.

Topics: Adolescent; Aldosterone; Anesthetics, Inhalation; Anesthetics, Intravenous; Atrial Natriuretic Factor; Female; Fentanyl; Humans; Isoflurane; Male; Oliguria; Renin; Renin-Angiotensin System; Scoliosis; Spinal Fusion; Sufentanil; 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