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Effects of general anaesthesia and surgery on renal function and plasma adh levels

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Summary

Plasma levels of antidiuretic hormone (ADH) were evaluated in 40 adult patients during and after various types of anaesthesia and surgery. The plasma level of ADH increased significantly 30 minutes after the start of anaesthesia with diethyl-ether (3.7 times) and after thiopentone (1.5 times), but it increased insignificantly in neuroleptanaesthesia (2.4 times) and with halothane (1.3 times). The surgical stress evoked marked increases in plasma ADH levels especially at ten minutes after the skin incision. A slight increase in plasma ADH level still continued into the early post-operative days.

The effects of halothane anaesthesia on plasma levels of ADH and on both cortical and medullary renal blood flow (RBF) were investigated in dogs. RBF was measured by means of a heated thermocouple in two groups of eight dogs each. One group was given a high fluid load of 30 ml/kg/hr and the other a low load of 10 ml/kg/hr. The plasma level of ADH increased significantly with deepening halothane anaesthesia in the low fluid load group. However, in the high fluid load dogs it remained unchanged in spite of an increasing inspired halothane concentration. Both cortical and medullary RBF fell significantly as compared with the control values in the low fluid load group. However, in the high fluid load dogs no significant decrease was observed. These results would indicate that the anaesthetic agents investigated in the present study caused increases in plasma ADH levels, but that these antidiuretic effects of anaesthesia might be modified by the volume of fluid infused during anaesthesia and operation.

Résumé

Pendant et après la chirurgie sous différents agents anesthésiques, on a déterminé la concentration plasmatique de ľhormone antidiurétique (ADH) chez 40 patients adultes opérés pour des pathologies abdominales variées. Une augmentation significative de ľADH a été notée après 30 minutes ďanesthésie à ľéther diéthylique (3.7 fois le contrôle) et le thiopentone (1.5 fois). Cette augmentation n’a pas été jugée significative après la neuroleptanesthésie (2.4 fois) et ľanesthésie à ľhalothane (1.3 fois). Le stress chirurgical a provoqué une augmentation importante, surtout à ta dixième minute après ľincision. Le niveau sanguin est demeuré légèrement élevé dans la période post-opératoire immédiate.

Les effets de ľanesthésie à ľhalothane sur la concentration plasmatique de ľADH et sur le flux sanguin rénal cortical et médullaire ont aussi fait ľobjet ďune étude chez le chien. Dans deux groupes de huit chiens, on a mesuré au thermocouple le flux sanguin rénal. Le premier groupe a reçu une surcharge liquidienne de 30 ml/kg/hre alors que ľapport n’a été que de 10 ml/kg/hre pour le deuxième groupe. La concentration plasmatique ďADH s’est élevée de façon significative dans le deuxième groupe. Toutefois, dans le premier groupe qui avait reçu le plus grand volume liquidien, le niveau plasmatique ďADH n’a pas changé malgré les augmentations de concentration de ľhalothane. Dans le groupe où ľapport liquidien a été le moins élevé, le flux sanguin cortical et le flux médullaire ont diminué de façon significative par comparaison aux valeurs de contrôle de ce groupe. Cette diminution n’a pas été notée pour le groupe surchargé. Ces résultats suggèrent que les agents anesthésiques utilisés dans cette étude augmentent le niveau ďADH, mais que les effets antidiurétiques de ľanesthésie peuvent ïtre modifiés par la quantité de liquide perfusée pendant ľanesthésie et ľopération.

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Correspondence to H. Ishihara or K. Ishida or T. Uyama or T. Kudo or M. Kudo.

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Ishihara, H., Ishida, K., Uyama, T. et al. Effects of general anaesthesia and surgery on renal function and plasma adh levels. Canad. Anaesth. Soc. J. 25, 312–318 (1978). https://doi.org/10.1007/BF03005655

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Keywords

  • Nitrous Oxide
  • Halothane
  • Renal Blood Flow
  • Thiopentone
  • Fluid Load