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- Title
Elucidating the relationship between cardiac preload and renal perfusion under pneumoperitoneum.
- Authors
Bergman, Simon; Nutting, Arni; Feldman, Liane; Vassiliou, Melina; Andrew, Christopher; Demyttenaere, Sebastian; Woo, Debbie; Carli, Franco; Jutras, Luc; Buthieu, Jean; Stanbridge, Donna; Fried, Gerald; Feldman, Liane S; Vassiliou, Melina C; Andrew, Christopher G; Stanbridge, Donna D; Fried, Gerald M
- Abstract
<bold>Introduction: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
ARTIFICIAL pneumoperitoneum; KIDNEY diseases; CARDIOPULMONARY system; DISEASES; SWINE; HEMORRHAGE; LASER Doppler velocimeter; NITROGLYCERIN; ANIMAL experimentation; BLOOD pressure; CARBON dioxide; CARDIOVASCULAR disease diagnosis; SURGICAL diagnosis; ECHOCARDIOGRAPHY; HEART; LEFT heart ventricle; HEART physiology; RENAL circulation; STROKE volume (Cardiac output)
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2006, Vol 20, Issue 5, p794
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-005-0086-9