title: Plasma pro-atrial natriuretic peptide to indicate fluid balance during cystectomy: a prospective observational study.
abstract: During surgery the volume of administered fluid is debated. Pro-atrial natriuretic peptide (proANP) is released by atrial distension, and we evaluated the relationship between changes in proANP associated with perioperative fluid balance.
  
  
  
  Prospective observational study.
  
  
  
  One university/tertiary centre.
  
  
  
  The study included patients who underwent radical cystectomy. Plasma for determination of proANP was obtained before surgery, after resection of the bladder, and at the end of surgery for 20 robotic-assisted radical cystectomy (RARC) and 20 open radical cystectomy (ORC) procedures.
  
  
  
  The blood loss was 1871 (95% CI 1267 to 2475) vs 589 mL (378 to 801) in the ORC and RARC groups (p=0.001), respectively, and fluid balance was positive by 1518 mL (1215 to 1821) during ORC, and by 1858 mL (1461 to 2255) during RARC (p=0.163). Yet, at the end of ORC, plasma proANP was reduced by 23% (14% to 32%, p=0.001), while plasma proANP did not change significantly during RARC. Thus, plasma proANP was associated both with the perioperative blood loss (r= -0.475 (0.632 to -0.101), p=0.002), and with fluid balance (r=0.561 (0.302 to 0.740), p=0.001), indicating that a stable plasma proANP required a fluid surplus by 2.4 L (2.0 to 2.7).
  
  
  
  There was a correlation between intraoperative haemorrhage and a decrease in plasma proANP and, taking plasma proANP to indicate filling of the heart, about 2.5 L surplus volume of lactated Ringer's solution appears to maintain cardiac preload during cystectomy.
  
  
  
  EudraCT (2012-005040-20), Results.
authors.affiliation: Departments of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Rasmussen
authors.affiliation: Departments of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Højskov
authors.affiliation: Departments of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Ruhnau
authors.affiliation: Department of Urology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Salling
authors.affiliation: Center for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Tom
authors.initials: T
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Goetze
authors.affiliation: Departments of Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015653:Cystectomy; D005260:Female; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood; D011446:Prospective Studies; D000077331:Ringer's Solution; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
chemical_list: D007552:Isotonic Solutions; D000077331:Ringer's Solution; D009320:Atrial Natriuretic Factor