The polypeptide relaxin (RLX) has been suggested to play a role in cardiorenal integration and to be related to the natriuretic peptide system. We hence examined the effects of variations in thoracic blood volume and intravenous volume loading on plasma and urinary RLX levels and associated changes in natriuretic peptide levels in healthy men. Two groups of eight subjects were randomly tilted into a 15 degrees feet-down or a 15 degrees head-down position. Ten volunteers were crossover subjected to an infusion of 15 ml/kg of 0.9% NaCl (over 60 min) or control during an observation period of 10 h. Blood and urine were sampled at timed intervals. RLX, NH(2)-terminal prohormones of atrial natriuretic peptide (NT-pro-ANP), and NH(2)-terminal prohormones of brain natriuretic peptide (NT-pro-BNP) were determined by enzyme, radio-, and electrochemoluminescence immunoassays, respectively. NT-pro-ANP levels (in percentage of baseline levels) were higher (P < 0.05) during the head-down (124 +/- 13%) than during the feet-down position (82 +/- 6%). NT-pro-BNP and RLX were not affected by tilting. Volume loading induced a short-lasting increase in plasma NT-pro-ANP, a delayed increase in plasma NT-pro-BNP, had no effect on plasma RLX, and induced a parallel increase in urine flow, renal excretion of sodium, RLX, and NT-pro-BNP. It is concluded that variations in thoracic blood volume in healthy men are not associated with variations in plasma RLX. Increased urinary RLX and NT-pro-BNP excretion during volume loading suggest renal production and a possible role of kidney-derived RLX and brain natriuretic peptide in sodium homeostasis in men.

A major complication of transurethral resection of the prostate (TURP) is the excessive absorption of irrigation solution resulting in hypervolemia and dilutional hyponatremia. Marking the irrigation fluid with ethanol is a method for the early detection of fluid absorption. Currently this method is being used in spontaneously breathing patients undergoing regional anaesthesia. The goal of this study was to determine whether this method is also reliable for patients undergoing general anaesthesia. Fifty-nine patients underwent TURP in either spinal anaesthesia (SPA), or general anaesthesia with semi-open (ITNO) and semi-closed (ITNC) systems. Plasma alcohol concentrations ([Eth]p), exhaled ethanol ([Eth]e), plasma sodium concentration ([Na+]), and central venous pressure (CVP) were measured. The irrigation fluid contained ethanol in an concentration of approx. 1%. We assumed that significant fluid absorption took place when [Eth]p exceeded 0.1/1000. Measurements were performed immediately prior to and during surgery at 10-minute intervals. [Eth]p correlated directly with [Eth]e for both forms of anaesthesia. [Eth]p and [Na+] correlated inversely both for SPA and ITNC. Changes in [Eth]p did not parallel changes in CVP. Clinically relevant episodes of fluid absorption were accompanied by the detection of exhaled ethanol in all groups. We conclude that measuring exhaled ethanol is a minimal invasive monitoring technique that allows the detection of significant fluid absorption in both spontaneously breathing as well as ventilated patients with sufficient sensitivity. The ethanol levels are not predictive of the sodium concentration both in SPA and general anaesthesia. Thus, additional determinations of [Na+] is recommended whenever [Eth]e exceeds 0.2/1000.

The systolic and diastolic blood pressure remained stable in both groups during and after treatment. The mean heart rate was different between the two groups at the beginning, and after the end of the treatment it dropped in both groups, but no significant difference was seen between groups. The PicCO2 rose from an initial mean of 36.8 mm Hg to a maximum of 44.6 mm Hg after 1000 shock waves in the sufentanil group, and from 37.8 mm Hg to 46.0 mm Hg after 2000 shock waves in the alfentanil group. The differences were significant within groups until 1 h after the end of the treatment, but there was no significant difference between groups. The oxygen saturation SpO2 dropped slightly in both groups. The differences were not significant between groups. In the alfentanil group, one patient had a maximum carbon dioxide tension of 83 mm Hg after 2000 shock waves, whereas in the sufentanil treated group the oxygen saturation fell to 72% in one case. (ABSTRACT TRUNCATED)

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