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Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine

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Abstract

Background

Increased intra-abdominal pressure (IAP) (pneumoperitoneum) during laparoscopic surgery may result in adverse effects on kidney function. The mechanisms underlying this phenomenon have not been fully determined.

Objective

The present study was designed to: (1) investigate the effects of incremental increases in IAP on renal function in normal rats and (2) evaluate whether the nitric oxide (NO) system is involved in renal dysfunction characterizing pneumoperitoneum.

Methods

Male rats were organized into two groups. The first group was subjected to IAP of 0 (baseline), 7 or 14 mmHg, over 1 h for each pressure, followed by a deflation period of 60 min (recovery). Two additional groups were pretreated with: (1) non-depressor dose of nitroglycerine (NTG) and (2) nitro-L-arginine-methylester (L-NAME), an NO synthase inhibitor, before applying 14 mmHg for 1 h. Urine flow rate (V), Na+ excretion (UNaV), glomerular filtration rate (GFR), renal plasma flow (RPF), and blood pressure were determined throughout the experiments.

Results

There were no significant changes in V, UNaV, GFR, and RPF during 7 mmHg insufflation. However, significant reductions in these parameters were observed during 14 mmHg: V from 8.49 ± 0.92 to 6.12 ± 0.54 μl/min, UNaV from 1.29 ± 0.28 to 0.39 ± 0.09 μEq/min, and FENa from 0.37 ± 0.11 to 0.27 ± 0.04%. These alterations in excretory functions were associated with a considerable decline in GFR from 1.85 ± 0.09 to 0.88 ± 0.09 ml/min, p < 0.05, (−46.3 ± 5.2% from baseline) and RPF from 8.66 ± 0.62 to 4.33 ± 0.49 ml/min, p < 0.05, (−51.93 ± 5.24% from baseline), without a significant change in mean arterial blood pressure (MAP). When the animals were pretreated with NTG, the adverse effects of pneumoperitoneum on V, UNaV, GFR, and RPF were substantially improved, suggesting that NO system plays a beneficial counter-regulatory role during laparoscopy. In line with this notion, pretreatment with L-NAME remarkably aggravated pneumoperitoneum-induced renal hypoperfusion and dysfunction.

Conclusion

Decreased renal perfusion and function are induced by IAP pressure of 14 mmHg. These adverse effects are probably related to interference with the NO system, and could be partially ameliorated by pretreatment with NTG.

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Acknowledgements

The authors are grateful to Mrs. Hoda Awad, and Aviva Kaballa for their expert technical assistance.

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Authors and Affiliations

  1. Department of General Surgery “A”, Rambam-Human Health Care Campus, Haifa, Israel

    Bishara Bishara

  2. Department of Vascular Surgery and Kidney Transplantation, Rambam-Human Health Care Campus, Haifa, Israel

    Tony Karram, Henry Schwartz, Aaron Hoffman & Zaid Abassi

  3. Department of Anesthesiology, Rambam-Human Health Care Campus, Haifa, Israel

    Samer Khatib

  4. Department of Nephrology, Rambam-Human Health Care Campus, Haifa, Israel

    Rawi Ramadan

  5. Department of Physiology and Biophysics, Ruth & Bruce Rappaport Faculty of Medicine, Technion, IIT, P.O. Box 9649, Haifa, 31096, Israel

    Zaid Abassi

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  1. Bishara Bishara
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Correspondence to Zaid Abassi.

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Bishara Bishara and Tony Karram contributed equally.

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Bishara, B., Karram, T., Khatib, S. et al. Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine. Surg Endosc 23, 568–576 (2009). https://doi.org/10.1007/s00464-008-9881-4

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  • DOI: https://doi.org/10.1007/s00464-008-9881-4

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