A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow.
OBJECTIVE
To determine if increasing nitric oxide bioactivity by inclusion of ethyl nitrite (ENO) in the insufflation admixture would attenuate pneumoperitoneum-induced decreases in splanchnic perfusion.


BACKGROUND
Organ blood flow is reduced during pneumoperitoneum and can contribute to laparoscopy-associated morbidity and mortality. Previous attempts to control such decreases in flow have been ineffective.


METHODS
Laser-Doppler flow probes were placed on the liver and right kidney of anesthetized pigs. After a baseline recording period, animals were insufflated to a final intraperitoneal pressure of 15 mm Hg. Group one received CO2 (standard practice), whereas group 2 received CO2 plus 100 ppm ENO. Insufflation was maintained for 60 minutes and then the abdomen was manually deflated; monitoring was continued for another 60 minutes.


RESULTS
CO2 insufflation (n = 5) cut liver blood flow in half; liver flow remained at this level throughout the postinsufflation period. Inclusion of 100 ppm ENO (n = 6) attenuated both the acute and prolonged blood flow decreases. Statistical modeling of the data showed that, on average, liver blood flow was 14.3 U/min higher in the ENO pigs compared with the CO2 group (P = 0.0454). In contrast, neither treatment significantly altered kidney blood flow (P = 0.6215).


CONCLUSIONS
The data indicate that ENO can effectively attenuate pneumoperitoneum-induced blood flow decreases within the peritoneal cavity. The result suggests a novel therapeutic method of regulating hemodynamic changes during laparoscopic procedures.
Ali
Nishath Athar
NA
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Eubanks
W Steve
WS
Stamler
Jonathan S
JS
Gow
Andrew J
AJ
Lagoo-Deenadayalan
Sandhya A
SA
Villegas
Leonardo
L
El-Moalem
Habib E
HE
Reynolds
James D
JD
D000818:Animals; D004305:Dose-Response Relationship, Drug; D007668:Kidney / Q000098:blood supply*; D008099:Liver / Q000098:blood supply*; D009573:Nitrites / Q000494:pharmacology*; D011028:Pneumoperitoneum, Artificial; D012039:Regional Blood Flow / Q000187:drug effects; D013152:Splanchnic Circulation / Q000187:drug effects*; D013552:Swine
D009573:Nitrites; C032712:ethyl nitrite