Abstract
Prostaglandin E1, (PGE,) is used to induce deliberate hypotension during anaesthesia. The purpose of this study was to compare the PGE1 induced diuretic effect in anaesthetized patients with and without lumbar epidural anaesthesia. The changes in haemodynamic variables, urinary flow, one-hour creatinine clearance (Ccr), and fractional excretion of sodium (FENa) during injection of PGE1, or a vehicle were compared in 42 surgical patients during enflurane anaesthesia with lumbar epidural anaesthesia (EPI group) with those in 44 surgical patients during enflurane anaesthesia alone (GA group). Patients in the GA group demonstrated increases in urinary flow (114 ± 46%) (mean ± SE), Ccr (74 ± 26%), and FENa (54 ± 23%) during PGE1, infusion, which were not observed in the patients in the EPI group. Mean arterial pressure decreased during PGE1, infusion from 92 ± 3 to 70 ± 2 mmHg in the GA group (P < 0.01) and from 85 ± 2 to 65 ± 1 mmHg in the EPI group (P < 0.01). Plasma antidiuretic hormone concentration during surgery was 12.5 ± 2.6 U. L−1 in the GA group and 2.3 ± 0.8 U· L−1 in the EPI group (P < 0.001). It is concluded that PGE1 induced diuresis was prevented by lumbar epidural anaesthesia.
Résumé
La prostaglandine E1 (PGE1,) est utilisé en anesthésie pour induire une hypotension contrôlée. L’objectif de cette étude est de comparer l’effet diurétique induit par la PGE1 chez les patients anesthésiés avec et sans anesthésie épidurale lombaire. Pendant la perfusion de la PGE1 ou bien celle d’un soluté inactif, on a comparé les modifications de variables hémodynamiques, du débit urinaire, de la clairance horaire de la créatinine (Ccr) et de la fraction excrétée du sodium (FENa) entre un groupe de 42 patients opérés sous enflurane en plus d’une anesthésie épidurale lombaire (groupe EPI) et un groupe de 44 patients sous enflurane seul (groupe AG). Les patients dans le groupe AG ont eu une augmentation significative du débit urinaire (114 ± 46%) (moyenne ± erreur- type), de Ccr (74 ± 26%) et de FENa (54 ± 23%) pendant la perfusion de PGE1, augmentation non observée chez les patients du groupe EPI. La pression artérielle moyenne a diminué pendant la perfusion de PGE1, de 92 ± 3 à 70 ± 2 mmHg dans le groupe GA (P < 0.01) et de 85 ± 2 à 65 ± 1 mmHg dans le groupe EPI (P < 0,01). La concentration plasmatique de l’hormone antidiérutique pendant la chirurgie a été de 12,5 ± 2,6 U · L−1 dans le groupe GA et de 2,3 ± 0,8 U · L−1 dans le groupe EPI (P < 0,001). Il est conclu que la diurèse induite par la PGE1 est prévenue par l’anesthésie épidurale lombaire.
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References
Miller ED. Deliberate hypotension.In: Miller RD (Ed.). Anesthesia 2nd ed. New York: Churchill Livingstone 1986; 1949–70.
Behnia R, Siqueira EB, Brunner EA. Sodium nitroprusside-induced hypotension: effect on renal function. Anesth Analg 1978; 57: 521–6.
Dohi S, Matsumoto M, Takahashi T. The effects of nitroglycerin on cerebrospinal fluid pressure in awake and anesthetized humans. Anesthesiology 1981; 54: 511–4.
Marsh ML, Shapiro HM, Smith RW, Marshall LE Changes in neurologic status and intracranial pressure associated with sodium nitroprusside administration. Anesthesiology 1979; 51: 336–8.
Goto F, Otani E, Kalo S, Fujita T. Prostaglandin E1 as a hypotensive drug during general anaesthesia. Anaesthesia 1982; 37: 530–5.
Anderson RJ, Berl T, McDonald KM, Schrier RW. Prostaglandins: effects on blood pressure, renal blood flow, sodium and water excretion (Editorial). Kidney Int 1976; 10: 205–15.
Inscho EW, Caimines PK, Navar LG. Prostaglandin influences on afferent arteriolar responses to vasoconstrictor agonists. Am J Physiol 1990; 259: F157–63.
Gross JB, Bartter FC. Effects of prostaglandins E1, A1, and F2a on renal handling of salt and water. Am J Physiol 1973; 225: 218–24.
Altsheler P, Klahr S, Rosenbaum R, Slatopolsky E. Effects of inhibitors of prostaglandin synthesis on renal sodium excretion in normal dogs and dogs with decreased renal mass. Am J Physiol 1978; 235: F338–44.
Berl T, Schrier RW. Mechanism of effect of prostaglandin E1 on renal water excretion. J Clin Invest 1973; 52: 463–71.
Beck TR, Dunn MJ. The relationship of antidiuretic hormone and renal prostaglandins. Miner Electrolyte Metab 1981; 6: 46–59.
Grantham JJ, Orloff J. Effect of prostaglandin E1 on the permeability response of the isolated collecting tubule to vasopressin, adenosone 3′,5′-monophosphate, and theophylline. J Clin Invest 1968; 47: 1154–61.
Lipson LC, Sharp GWG. Effect of prostaglandin E1 on sodium transport and osmotic water flow in the toad bladder. Am J Physiol 1971; 220: 1046–52.
Bonnet F, Harari A, Thibonnier M, Viars P. Suppression of antidiuretic hormone hypersecretion during surgery by extradural anaesthesia. Br J Anaesth 1982; 54: 29–36.
Adams HA, Biscoping J, Baumann P, Börgmann A, Hempelmann G. Maternal and fetal stress responses during cesarean section. Reg Anaesth 1989; 12: 87–94.
Pelayo JC, Ziegler MG, Jose PA, Blantz RC. Renal denervation in the rat: analysis of glomerular and proximal tubular function. Am J Physiol 1983; 244: F70–7.
Sladen RN, Endo E, Harrison T. Two-hour versus 22-hour creatinine clearance in critically ill patients. Anesthesiology 1987; 67: 1013–6.
Richardson JA, Philbin PE. The one-hour creatinine clearance rate in healthy men. JAMA 1971; 216: 987–90.
Stokes JB. Integrated actions of renal medullary prostaglandins in the control of water excretion (Editorial). Am J Physiol 1981; 240: F471–80.
Reineck HJ, Stein JH. 3. Sodium metabolism.In: Maxwell MH, Kleeman CR, Narins RG (Eds.). Clinical Disorders of Fluid and Electrolyte Metabolism, 4th ed. New York: McGraw-Hill Book Co. 1987; 33–59.
Beck TR, Levenson DJ, Brernner BM. 15. Renal prostaglandins and kinins.In: Maxwell MH, Kleeman CR, Narins RG (Eds.). Clinical Disorders of Fluid and Electrolyte Metabolism 4th ed. New York: McGraw-Hill Book Co. 1987: 343–70.
Beck, NP, Kaneko T, Zor U, Field JB, Davis BB. Effects of vasopressin and prostaglandin E1 on the adenyl cyclasecyclic 3′,5′-adenosine monophosphate system of the renal medulla of the rat. J Clin Invest 1971; 50: 2461–5.
Kanto J, Vinamäki O, Grönroos M, Lammintausta R, Liukko P. Blood glucose, insulin, antidiuretic hormone and renin activity response during caesarean section performed under general anaesthesia or epidural analgesia. Acta Anaesthesiol Scand 1981; 25: 442–4.
DiBona GF, Sawin LL. Effect of renal nerve stimulation on NaCl and H2O transport in Henle’s loop of the rat. Am J Physiol 1982; 243: F576–80.
Preece MJ, Richardson JA. The effect of mild dehydration on one-hour creatinine clearance rates. Nephron 1972; 9: 106–12.
Wilson RF, Soullier G. The validity of two-hour creatinine clearance studies in critically ill patients. Crit Care Med 1980; 8: 281–4.
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Yamaguchi, H., Hamkuni, I., Dohi, S. et al. Lumbar epidural anaesthesia prevented prostaglandin E1 — induced diuretic effect in enflurane anaesthetized patients. Can J Anaesth 40, 619–624 (1993). https://doi.org/10.1007/BF03009698
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DOI: https://doi.org/10.1007/BF03009698