title: A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Nishath Athar
authors.initials: NA
authors.lastname: Ali
authors.forename: W Steve
authors.initials: WS
authors.lastname: Eubanks
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Stamler
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gow
authors.forename: Sandhya A
authors.initials: SA
authors.lastname: Lagoo-Deenadayalan
authors.forename: Leonardo
authors.initials: L
authors.lastname: Villegas
authors.forename: Habib E
authors.initials: HE
authors.lastname: El-Moalem
authors.forename: James D
authors.initials: JD
authors.lastname: Reynolds
mesh_terms: 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
chemical_list: D009573:Nitrites; C032712:ethyl nitrite