Splanchnic and Renal Deterioration During and After Laparoscopic Cholecystectomy

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Abstract
Carbon dioxide (CO,) pneumoperitoneum together (P < 0.05) for 3 h postoperatively in the control group. with an increased intraabdominal pressure (IAP) in- Diuresis was less (P < 0.01) and U-NAG levels (P < 0.01) duces a hemodynamic stress response, diminishes higher in the control group. The pHi decreased after urine output, and may compromise splanchnic perfu- induction of pneumoperitoneum up to three hours sion. A new retractor method may be less traumatic. postoperatively and remained intact in the retractor Accordingly, 30 ASA physical status I or II patients un- group. We conclude that the retractor method for lapa- dergoing laparoscopic cholecystectomy were ran- roscopic cholecystectomy ensures stable hemodynam- domly allocated to a CO, pneumoperitoneum (IAP 12- its, prevents respiratory acidosis, and provides protec- 13 mm Hg) (control) or to a gasless abdominal wall lift tion against biochemical effects, which reveal the renal method (retractor) group. Anesthesia and intravascular and splanchic ischemia caused by CO, insufflation. Im- fluids were standardized. Direct mean arterial pressure plications: A mechanical retractor method (gasless) (MAI'), urine output, urine-iv-acetyl-/3-n-glucosaminidase was compared with conventional CO, pneumoperito- (U-NAG), arterial blood gases, gastric mucosal Pco,, neum for laparoscopic cholestectomy. The gasless and intramucosal pH (pHi) were measured. Normov- method ensured stable hemodynamics, prevented re- entilation was instituted in all patients. MAP increased spiratory acidosis, and provided protection against the (P < 0.001) only with CO, pneumoperitoneum. Minute renal and splanchnic ischemia seen with CO, volume of ventilation had to be increased by 35% pneumoperitoneum. with CO, insufflation. Pace, was significantly higher (Anesth Analg 1997;85:886-91)