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Activation of the renin–angiotensin system contributes significantly to the pathophysiology of oliguria in patients undergoing posterior spinal fusion

Published online by Cambridge University Press:  28 January 2005

J. Guay  and
L. Lortie
J. Guay
Affiliation:
Maisonneuve-Rosemont Hospital, Department of Anaesthesiology, University of Montreal, Quebec, Canada
L. Lortie
Affiliation:
Research Center of Ste-Justine Hospital, Montreal, Quebec, Canada
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Extract

Summary

Background and objective: 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.

Methods: Sixteen patients undergoing posterior spinal fusion using isoflurane and fentanyl (n = 8) or sufentanil (n = 8) had renin, aldosterone, ADH and ANF measurements.

Results: 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 12 h (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), 8 h (r2 = 0.26, P = 0.04) and 12 h (r2 = 0.31, P = 0.03), aldosterone at 6 h (r2 = 0.54, P = 0.001), 8 h (r2 = 0.40, P = 0.01) and 12 h (r2 = 0.32, P = 0.03), ADH at 24 h (r2 = 0.38, P = 0.01) and ANF at 6 h (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).

Conclusion: 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.

Keywords

SURGERY, scoliosis, spinal fusionOLIGURIA, intraoperative, postoperativePITUITARY HORMONES POSTERIOR, vasopressinATRIAL NATRIURETIC FACTORALDOSTERONERENIN–ANGIOTENSIN SYSTEM
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 10 , October 2004 , pp. 812 - 818
Copyright
© 2004 European Society of Anaesthesiology

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References

Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 2002; 359: 1812–1818.Google Scholar
Guay J, Reinberg C, Poitras B, et al. A trial of desmopressin to reduce blood loss in patients undergoing spinal fusion for idiopathic scoliosis. Anesth Analg 1992; 75: 405–410.Google Scholar
Burrows FA, Shutack JG, Crone RK. Inappropriate secretion of antidiuretic hormone in a postsurgical pediatric population. Crit Care Med 1983; 11: 527–531.Google Scholar
Elster AD. Hyponatremia after spinal fusion caused by inappropriate secretion of antidiuretic hormone (SIADH). Clin Orthopedic Relat Res 1985; 194: 136–141.Google Scholar
Bell GR, Gurd AR, Orlowski JP, Andrish JT. The syndrome of inappropriate antidiuretic-hormone secretion following spinal fusion. J Bone Joint Surg 1986; 68A: 720–723.Google Scholar
Hering R, Wrigge H, Vorwerk R, et al. The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury. Anesth Analg 2001; 92: 1226–1231.Google Scholar
Rylance PB, Carli F, Mc Arthur SE, Ransford AO, Mansell MA. The effect of induced hypotension and tissue trauma on renal function in scoliosis surgery. J Bone Joint Surg 1988; 70B: 127–129.Google Scholar
Lieh-Lai MW, Stanitski DF, Sarnaik AP, et al. Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion. Crit Care Med 2000; 28: 3126–3127.Google Scholar
Cregg N, Mannion D, Casey W. Oliguria during corrective spinal surgery for idiopathic scoliosis: the role of antidiuretic hormone. Paediatr Anaesth 1999; 9: 505–514.Google Scholar
Kano T. Fluctuation in plasma ADH levels during and after surgery of esophageal cancer. J Jap Surg Soc 1986; 87: 1398–1405.Google Scholar
Kudoh A, Ishihara H, Matsuki A. Renin–aldosterone system and atrial natriuretic peptide during anesthesia in orthopedic patients over 80 yr of age. J Clin Anesth 1999; 11: 101–107.Google Scholar
Levine JP, Stelnicki E, Weiner HL, Bradley JP, McCarthy JG. Hyponatremia in the postoperative craniofacial pediatric patient population: a connection to cerebral salt wasting syndrome and management of the disorder. Plast Reconstr Surg 2001; 108: 1501–1508.Google Scholar
DeGasperi A, Cristalli A, Corti A. Changes in circulating levels of atrial natriuretic factor (ANF) during orthotopic liver transplantation in humans. Transpl Int 1994; 7 (Suppl 1): S134–S138.Google Scholar
Gutkowska J, Schiffrin EL, Cantin M, Genest J. Effect of dietary sodium on plasma concentration of immunoreactive atrial natriuretic factor in normal humans. Clin Invest Med 1986; 9: 222–224.Google Scholar
Tambe AA, Hill R, Livesley PJ. Post-operative hyponatraemia in orthopaedic injury. Injury 2003; 34: 253–255.Google Scholar
Adams HA, Ratthey K, Rupp D, Hempelmann G. Endokrine reaktionen bei akuter normovolamischer hemodilution. Anaesthesist 1990; 39: 269–274.Google Scholar
Tsubo T, Isozaki K, Sato T, Araki I, Ishihara H, Matsuki A. Hemodynamic and endocrine responses to prostaglandin E1 induced hypotension during enflurane anesthesia in surgical patients: evaluation by transesophageal echocardiography. Jpn J Anesthesiol 1993; 42: 66–70.Google Scholar
Pathak KS, Anton AH, Sutheimer CA. Effects of low-dose morphine and fentanyl infusions on urinary and plasma catecholamine concentrations during scoliosis surgery. Anesth Analg 1985; 64: 509–514.Google Scholar
Monk TG, Mueller M, White PF. Treatment of stress response during balanced anesthesia. Comparative effects of isoflurane, alfentanil, and trimethaphan. Anesthesiology 1992; 76: 39–45.Google Scholar
Mirenda JV, Grissom TE. Anesthetic implications of the renin–angiotensin system and angiotensin-converting enzyme inhibitors. Anesth Analg 1991; 72: 667–683.Google Scholar
Rossaint R, Krebs M, Forther J, Unger V, Falke K, Kaczmarczyk G. Inferior vena caval pressure increase contributes to sodium and water retention during PEEP in awake dogs. J Appl Physiol 1993; 75: 2484–2492.Google Scholar
Zayas VM, Blumenfeld JD, Bading B, et al. Adrenergic regulation of renin secretion and renal hemodynamics during deliberate hypotension in human. Am J Physiol 1993; 265: F686–F692.Google Scholar
Hopf HB, Schlaghecke R, Peters J. Sympathetic neural blockade by thoracic epidural anesthesia suppresses renin release in response to arterial hypotension. Anesthesiology 1994; 80: 992–999.Google Scholar
Mayer N, Zimpfer M, Kotai E, Placheta P. Enflurane alters compensatory hemodynamic and humoral responses to hemorrhage. Circ Shock 1990; 30: 165–178.Google Scholar
Edwards BS, Zimmerman RS, Schwab TR, Heublein DM, Burnett Jr JC. Atrial stretch, not pressure, is the principal determinant controlling the acute release of atrial natriuretic factor. Circ Res 1988; 62: 191–195.Google Scholar
Langenbach MR, Korbmacher B, Schulte H, Zirngibl H, Grabensee B, Plum J. Perioperative levels of atrial natriuretic peptide and troponin-T in patients with uncomplicated coronary artery surgery. J Cardiovasc Surg (Torino) 2002; 43: 595–601.Google Scholar
Davis KL, Nappi JM. The cardiovascular effects of eplerenone, a selective aldosterone-receptor antagonist. Clin Ther 2003; 25: 2647–2668.Google Scholar
Clark MA, Lawson JA, Ludens JH. The natriuretic activity of the K+ channel blocker U-37883A displays an ADH-dependence. Method Find Exp Clin Pharmacol 1998; 20: 115–123.Google Scholar