Is pneumoperitoneum harmful during intra-abdominal hemorrhage in rats?
BACKGROUND
Laparoscopic surgical interventions are being used in trauma patients for diagnostic and therapeutic purposes, but there are limited studies on this subject. The effect of pneumoperitoneum during intra-abdominal hemorrhage has not been elucidated. The aim of this study was to investigate the hemodynamic, respiratory, and renal effects of pneumoperitoneum in the splenic injury/ hemorrhagic shock model in rats.


METHODS
In this study, 80 anesthetized Wistar male rats (294.5 +/- 31.2 g) were randomized into 2 main groups: nontraumatized (group A) and traumatized (group B). After initial preparation and monitoring, each group was divided according to the degree of pneumoperitoneum. The nontraumatized subgroups were A1, sham-operated; A2, 4-8 mm Hg; A3, 9-13 mm Hg; and A4, 14-18 mm Hg. The traumatized subgroups were B1, splenic injury without pneumoperitoneum; B2, B3, and B4, splenic injury with pneumoperitoneum at 4-8 mm Hg, 9-13 mm Hg, and 14-18 mm Hg, respectively. Mean arterial pressure, heart rate, and respiratory rate were monitored continuously. Blood samples were obtained for hemoglobin, hematocrit, arterial blood gases, and biochemical analyses. Twenty-four hour urine output was collected.


RESULTS
In group B4, pH, pCO2, and HCO3 levels were lower than in all other groups, while pCO2 and base deficit levels were significantly higher (P < 0.05). Both blood and urine analysis results showed that 24-hour urine output and the glomerular filtration rate of groups A4 and B4 were significantly lower (P < 0.05), while urinary osmolarity and fractional sodium excretion levels were significantly higher (P < 0.05).


CONCLUSIONS
High-pressure pneumoperitoneum in splenically traumatized rats amplifies acidosis, decreases urine output, decreases glomerular filtration rate, and increases urinary osmolarity and fractional sodium excretion significantly.
Bulut
Feridun
F
Department of Surgery, Ondokuz Mayis University School of Medicine, Samsun, Turkey.
Dervisoglu
Adem
A
Kesim
Mete
M
Guven
Hakan
H
Polat
Cafer
C
D000818:Animals; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D005919:Glomerular Filtration Rate; D006339:Heart Rate; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D008297:Male; D009318:Natriuresis; D009994:Osmolar Concentration; D010100:Oxygen / Q000097:blood; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D012143:Respiratory Physiological Phenomena; D012771:Shock, Hemorrhagic / Q000503:physiopathology*; D013154:Spleen / Q000293:injuries; D014556:Urine
D006454:Hemoglobins; D002245:Carbon Dioxide; D010100:Oxygen