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Elucidating the relationship between cardiac preload and renal perfusion under pneumoperitoneum

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Abstract

Introduction

Pneumoperitoneum is associated with a well-described decrease in renal blood flow, but it remains unclear whether a decrease in cardiac preload is responsible. Our aim was to characterize the relationship between cardiac preload and renal perfusion during pneumoperitoneum.

Methods

Eleven pigs were submitted to three 30 minute study periods: 1) Baseline (n=11): no interventions, 2) Pneumoperitoneum (n=11): 12 mmHg CO2 pneumoperitoneum, 3) Preload Reduction: pneumoperitoneum and nitroglycerin infusion (n=8); or pneumoperitoneum and hemorrhage to a mean arterial pressure (MAP) of 40 mmHg (n=3). Echocardiographic measurements of left ventricular end-diastolic diameter (LVEDD) were used as an index of preload. Renal cortical perfusion (RCP) was measured using laser doppler flowmetry.

Results

LVEDD decreased from 4.2 ± 0.5 to 4.1 ± 0.6 cm (p=0.02) with pneumoperitoneum and then to 4.0 ± 0.5 cm (p=0.03) with the addition of nitroglycerin. There was no statistically significant change in RCP with pneumoperitoneum (33.5 ± 8.4 to 28.5 ± 8.4 ml/min/100g tissue, p=0.2), but it decreased to 18.5 ± 11.3 ml/min/100g tissue (p=0.001) with the addition of nitroglycerin. The correlation between RCP and LVEDD was weak (0.35, p=0.003), whereas correlation between RCP and MAP was superior (R=0.59, p<0.0001).

Conclusions

While decreasing preload under extreme lab conditions also decreases RCP, simply creating a pneumoperitoneum of 12 mmHg does not. The decrease in renal blood flow associated with pneumoperitoneum is likely not solely a function of preload.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, QC, Canada

    Simon Bergman, Liane S. Feldman, Melina C. Vassiliou, Christopher G. Andrew, Sebastian Demyttenaere, Donna D. Stanbridge & Gerald M. Fried

  2. Department of Surgery, McGill University, Montreal, QC, Canada

    Simon Bergman, Liane S. Feldman, Melina C. Vassiliou, Christopher G. Andrew, Sebastian Demyttenaere, Debbie Woo & Gerald M. Fried

  3. Department of Anesthesia, McGill University, Montreal, QC, Canada

    Franco Carli

  4. Department of Pediatrics, McGill University, Montreal, QC, Canada

    Arni Nutting & Luc Jutras

  5. Department of Medicine, McGill University, Montreal, QC, Canada

    Jean Buthieu

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  1. Simon Bergman
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  2. Arni Nutting
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Correspondence to Simon Bergman.

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Bergman, S., Nutting, A., Feldman, L.S. et al. Elucidating the relationship between cardiac preload and renal perfusion under pneumoperitoneum. Surg Endosc 20, 794–800 (2006). https://doi.org/10.1007/s00464-005-0086-9

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  • DOI: https://doi.org/10.1007/s00464-005-0086-9

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