Plasma pro-atrial natriuretic peptide for monitoring central blood volume during upper gastrointestinal surgery (2019)


Maintaining central blood volume (CBV) during surgery is important for preserving oxygen supply to organs, and deviations in CBV may impair postoperative recovery and survival. CBV is not regularly assessed during surgery, but the circulation is monitored by, e.g., blood pressure, heart rate, and central venous pressure, which are insensitive measures for detecting a reduced CBV. The thesis evaluated plasma pro-atrial natriuretic peptide (proANP), a stable precursor of ANP, as an indicator of deviations in CBV during major upper abdominal surgery. Plasma ANP is released by atrial distention and increases when preload to the heart is enhanced, and – in contrast – decreases when venous return is reduced. Thus, a stable plasma proANP from start to end of surgery is taken to indicate a stable CBV.

The studies showed that a decrease in plasma proANP indicates a restricted CBV during major upper abdominal surgery. Thus, plasma proANP may qualify for estimating the fluid balance by the end of surgery, and thus may be applied to guide fluid therapy towards a stable CBV.

Additional project information

The project was carried out at the Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Denmark.

Place of employment

Department of Surgical Gastroenterology, CTx, Rigshospitalet, University of Copenhagen, Denmark

PhD author

Rune B. Strandby, MD, PhD

Date and place of defense

29th November, 2019, Department of Clinical Medicine, University of Copenhagen


Lars Bo Svendsen, MD, DMSci, Dep. of Surgical Gastroenterology
Niels H. Secher, MD, DMSci, Dep. of Anesthesia, 2043
Michael P. Achiam, MD, PhD, DMSci, Dep. of Surgical Gastroenterology
Jens P. Goetze, MD, DMSci, Dep. of Clinical Biochemistry


Study 1:PubMed
Study 2:PubMed
Study 3:PubMed
Study 4: In preparation for submission

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