A Method to Attenuate Pneumoperitoneum-Induced Reductions... : Annals of Surgery (original) (raw)

Original Articles

A Method to Attenuate Pneumoperitoneum-Induced Reductions in Splanchnic Blood Flow

Ali, Nishath Athar MD*†; Eubanks, W Steve MD‡; Stamler, Jonathan S. MD§∥; Gow, Andrew J. PhD§; Lagoo-Deenadayalan, Sandhya A. MD, PhD†; Villegas, Leonardo MD†; El-Moalem, Habib E. PhD*; Reynolds, James D. PhD*†

From the *Departments of Anesthesiology, †Surgery, and §Medicine, and ∥Howard Hughes Medical Institute, Duke University Medical Center, Durham, North Carolina; and the ‡Department of Surgery, University of Missouri–Columbia, Columbia, Missouri.

This work was support in part by National Institutes of Health grant HD042471 (JDR) and an unrestricted educational grant from United States Surgical Corporation (WSE). JSS is an associate investigator with the Howard Hughes Medical Institute.

Reprints: James Dixon Reynolds, PhD, Assistant Professor, Departments of Anesthesiology and Surgery, Room 119, Research Park Building 4, Box 3094, Duke University Medical Center, Durham, NC 27710. E-mail: [email protected].

Objective:

To determine if increasing nitric oxide bioactivity by inclusion of ethyl nitrite (ENO) in the insufflation admixture would attenuate pneumoperitoneum-induced decreases in splanchnic perfusion.

Summary Background Data:

Organ blood flow is reduced during pneumoperitoneum and can contribute to laparoscopy-associated morbidity and mortality. Previous attempts to control such decreases in flow have been ineffective.

Methods:

Laser-Doppler flow probes were placed on the liver and right kidney of anesthetized pigs. After a baseline recording period, animals were insufflated to a final intraperitoneal pressure of 15 mm Hg. Group one received CO2 (standard practice), whereas group 2 received CO2 plus 100 ppm ENO. Insufflation was maintained for 60 minutes and then the abdomen was manually deflated; monitoring was continued for another 60 minutes.

Results:

CO2 insufflation (n = 5) cut liver blood flow in half; liver flow remained at this level throughout the postinsufflation period. Inclusion of 100 ppm ENO (n = 6) attenuated both the acute and prolonged blood flow decreases. Statistical modeling of the data showed that, on average, liver blood flow was 14.3 U/min higher in the ENO pigs compared with the CO2 group (P = 0.0454). In contrast, neither treatment significantly altered kidney blood flow (P = 0.6215).

Conclusion:

The data indicate that ENO can effectively attenuate pneumoperitoneum-induced blood flow decreases within the perito-neal cavity. The result suggests a novel therapeutic method of regulating hemodynamic changes during laparoscopic procedures.