Advertisement

Surgical Endoscopy And Other Interventional Techniques

, Volume 16, Issue 9, pp 1297–1301 | Cite as

Role of dopamine in renal dysfunction during laparoscopic surgery

  • J. Pérez
  • P. Taurá
  • J. Rueda
  • J. Balust
  • T. Anglada
  • J. Beltran
  • A. M. Lacy
  • J. C. Garcia-Valdecasas
Original Articles

Abstract

Background

Sympathetic vascular insult and hemodynamic changes represent the most reliable explanation of renal impairment resulting from acute intraabdominal pressure. We evaluated the effects of low-dose dopamine administration during a long-lasting surgical laparoscopic procedure.

Methods

For this study 40, patients submitted to a colorectal laparoscopic procedure with 15 mmHg of intraabdominal pressure were randomly allocated to two groups: 20 receiving 2μg/kg/min of dopamine and 20 receiving the same perfusion of saline. Hemodynamic parameters, renal function, urinary output, and creatinine clearance, were studied.

Results

The hemodynamic parameters were similar in both groups. The urinary output decreased during the intraoperative period only the saline group (p=0.4). Then 2 h postoperatively, it increased in both groups, and no statistically significant differences were found between the groups. The creatinine clearance decreased in both groups during the intraoperative time, but it was worse in the saline group (−28±120 vs −194±106; p=0.022). During the postoperative period, both groups showed improvement, but in control group the values remained lower than at baseline (p=0.04), and significantly lower than in the dopamine group (230±337 vs 100±192; p=0.012).

Conclusions

An intrabdominal pressure of 15 mmHg induces a time-limited renal dysfunction, and low doses of dopamine could prevent this undesirable effect.

Key words

Laparoscopic surgery Renal impairment Dopamine Protective effect 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Agusti M, Elizalde J, Adalia R, Cifuentes A, Fontanals J, Taurá P (2000) Dobutamine restores intestinal mucosal blood flow in a porcine model of intraabdominal hyperpressure. Crit Care Med 28: 467–472PubMedCrossRefGoogle Scholar
  2. 2.
    Bailey JM (2000) Dopamine: one size does not fit all. Anesthesiology 92: 303–305PubMedCrossRefGoogle Scholar
  3. 3.
    Bersten AD, Rutten AJ, Summersides G, et al. (1992) Interaction of sepsis, adrenaline, and dopamine in awake sheep. Abstract of the 17th Australian and New Zealand Scientific Meeting on Intensive Care, Auckland, New Zealand, p 75.Google Scholar
  4. 4.
    Brogden RN, Markham A (1997) Fenoldopam: a review of its pharmacodynamic and pharmacokinetic properties and intravenous clinical potential in the management of hypertensive urgencies and emergencies. Drugs 54: 634–650PubMedCrossRefGoogle Scholar
  5. 5.
    Diebel LN, Wilson R, Dulchavsky S, Saxe J (1992) Effect of increased intraabdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma 33: 279–282PubMedGoogle Scholar
  6. 6.
    Duke GJ, Briedis JH, Weaver RA (1994) Renal support in critically ill patients: low-dose dopamine or low-dose dobutamine? Crit Care Med 22: 1919–1925PubMedGoogle Scholar
  7. 7.
    Dunn MD, McDougall EM (2000) Renal physiology: laparoscopic considerations. Urol Clin North Am 27: 609–614PubMedCrossRefGoogle Scholar
  8. 8.
    Hashikura Y, Kawasaki S, Munakata Y, Hashimoto S, Hayashi K, Makuuchi M (1994) Effect of peritoneal insufflation on hepatic and renal blood flow. Surg Enclosc 8: 759–761CrossRefGoogle Scholar
  9. 9.
    Iwase K, Takenaka H, Ishizaka T, Oshima S, Sakaguchi K (1993) Serial changes in renal function during laparoscopic cholecystectomy. Eur Surg Res 25: 203–212PubMedCrossRefGoogle Scholar
  10. 10.
    Jose PA, Asico LD, Gilbert ME et al. (1998) Ellects of costimulation of dopamine D1- and D2-like receptors on renal function. Am J Physiol R986–R994Google Scholar
  11. 11.
    Kellum JA, Decker JM (2001) Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med 29: 1526–1531PubMedCrossRefGoogle Scholar
  12. 12.
    Kirsch AJ, Hensle TW, Chang DT, Kayton ML, Olsson CA, Sawczuk IS (1994) Renal effects of CO2 insufflation: oliguria and acute renal dysfunction in a rat pneumoperitoneum model. Urology 43: 453–459PubMedCrossRefGoogle Scholar
  13. 13.
    Koivusalo AM, Scheinin M, Tikanen I, Yli-Suomu T, Ristkari S, Laakso J, Lindgren L (1998) Effects of esmolol on hemodynamic response to CO2 pneumoperitoneum for laparoscopic surgery. Acta Anaesthesiol Scand 42: 510–517PubMedCrossRefGoogle Scholar
  14. 14.
    Matsuda T, Fujise K, Matsumoto S, Mikami O, Uchida J, Shingu K (1996) Respiratory effects of CO2 pneumoperitoneum during transperitoneal laparoscopic urological surgery. Eur Urol 30: 484–489PubMedGoogle Scholar
  15. 15.
    McDougall EM, Monk TG, Wolf SJ (1996) The effect of prolonged pneumoperitoneum on renal function in an animal model. J Am Coll Surg 182: 317–328PubMedGoogle Scholar
  16. 16.
    Micali S, Silver IR, Kaufman HS, Douglas VD, Marley GM, Partin AW, Moore RG, Karoussi LR, Docino SG (1999) Measurement of urinary N-acetyl-D-glucosaminidase to assess renal ischemia during laparoscopic operations. Surg Endosc 13: 503–506PubMedCrossRefGoogle Scholar
  17. 17.
    Nishio S, Takeda H, Yokohama M (1999) Changes in urinary output during laparoscopic adrenalectomy. BJU Int 83: 944–947PubMedCrossRefGoogle Scholar
  18. 18.
    Olsen NV, Lund J, Jensen PF, Espersen K, Kanstrup IL, Plum I, Leyssac PP (1993) Dopamine, dobutamine, and dopexamine: a comparison of renal effects in unanesthetized human volunteers. Anesthesiology 79: 685–694PubMedGoogle Scholar
  19. 19.
    Rosenblum R, Tai AR, Lawson D (1979) Cardiac and renal hemodynamic effects of dopamine in man. Clin Res 18: 326–330Google Scholar
  20. 20.
    Sala X, Fontanals J, Taura P (1998) Effects of carbon dioxide vs helium pneumoperitoneum on hepatic blood How. Surg Endosc 12: 1121–1125CrossRefGoogle Scholar
  21. 21.
    Sladen RN, Endo E, Harrison T (1987) Two-hour versus 22-hour creatinine clearance in critically ill patients. Anesthesiology 67: 1013–1016PubMedCrossRefGoogle Scholar
  22. 22.
    Stuttmann R, Skelly A (1994) Laparoscopy and its complications. Minim Invasive Ther 3 (Suppl 2): 25–30Google Scholar
  23. 23.
    Tobias GJ, McLaughlin RF, Hooper J (1962) Endogenous creatinine clearance: a valuable clinical test of glomerular filtration and a prognostic guide in chronic renal disease N Engl J Med 266: 317–323PubMedCrossRefGoogle Scholar
  24. 24.
    Wesson LG, Lauler PD (1961) Diurnal cycle of glomerular filtration rate and sodium and chloride excretion during responses to altered salt water balance in men. J Clin Invest 40: 1967–1977PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • J. Pérez
    • 1
  • P. Taurá
    • 1
  • J. Rueda
    • 1
  • J. Balust
    • 1
  • T. Anglada
    • 1
  • J. Beltran
    • 1
  • A. M. Lacy
    • 2
  • J. C. Garcia-Valdecasas
    • 2
  1. 1.Anesthesiology Department, Hospital Clinic of BarcelonaUniversity of BarcelonaBarcelonaSpain
  2. 2.Digestive Surgery Department, Hospital Clinic of BarcelonaUniversity of BarcelonaBarcelonaSpain

Personalised recommendations