title: Modulation of aldosterone release by epidural analgesia impacts brain natriuretic peptide: a link to stress cardiomyopathy? Pilot study.
abstract: OBJECTIVE
  Data pertaining to whether stress-induced aldosterone release is associated with cardiac disorders are lacking. This study was designed to compare whether the modulation of intra-operative aldosterone release by epidural analgesia had an effect on the brain natriuretic peptide (BNP) levels.
  
  
  METHODS
  A study was pilot prospective, open label randomized one. Patients were randomized to one of two anaesthesia protocols: group 1 included 13 patients who received general anaesthesia, and group 2 included 12 patients who received combined general anaesthesia and epidural analgesia. Study protocol was by completed 25 male patients, median age 56 years, without significant comorbidities, who underwent radical cystectomy because of urinary bladder tumour. Serum aldosterone, BNP, cortisol (measured by radioimmunoassay), adrenocorticotropine hormone (ACTH) (by solid-phase ELSA), blood chemistry, complete blood count and vital signs were compared preoperatively, intra-operatively and at postoperative days (POD) 1 and 7.
  
  
  RESULTS
  Hemodynamics was stable in both groups. Group 1 showed threefold serum aldosterone, (P = 0·001) 20-fold ACTH (P = 0·003) and twofold cortisol (P = 0·001) increases intra-operatively, unlike group 2. Both groups had a twofold BNP increase in POD 1 that remained above normal on POD 7 only in group 1 (P = 0·02; P = 0·019 vs group 2).
  
  
  CONCLUSIONS
  Alleviation of aldosterone release by epidural analgesia modulated the postoperative serum BNP pattern in patients with a low risk for cardiac diseases who underwent noncardiac surgery.
authors.affiliation: Clinics of Anesthesiology, Clinical Centre of Serbia, University of Belgrade, School of Medicine, Belgrade, Serbia.
authors.forename: Mina
authors.initials: M
authors.lastname: Radović
authors.forename: Svetozar
authors.initials: S
authors.lastname: Damjanović
authors.forename: Djordje
authors.initials: D
authors.lastname: Nale
authors.forename: Sava
authors.initials: S
authors.lastname: Mićić
authors.forename: Dragan
authors.initials: D
authors.lastname: Vučović
authors.forename: Milan
authors.initials: M
authors.lastname: Radović
mesh_terms: D000450:Aldosterone / Q000378:metabolism*; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000768:Anesthesia, General; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D059035:Perioperative Period; D010865:Pilot Projects; D054549:Takotsubo Cardiomyopathy / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery
chemical_list: D020097:Natriuretic Peptide, Brain; D000450:Aldosterone