Effect of diltiazem on kidney function during laparoscopic surgery.
BACKGROUND
Pneumoperitoneum is known to be associated with transient impairment in kidney function. This study was designed to investigate the effect of diltiazem on acute kidney injury during positive pneumoperitoneum in patients undergoing laparoscopic surgery.


METHODS
Thirty-two patients of American Society of Anesthesiologists (ASA) 1 and 2 physical status undergoing laparoscopic surgery were randomly divided into control (normal saline infusion) and diltiazem groups (diltiazem 2 microg/kg/min). Urinary flow, urinary sodium excretion, creatinine clearance (CrCl), and hemodynamic variables were determined during pneumoperitoneum and at postoperative 2 h. CrCl using Cockcroft-Gault equation was calculated before surgery (baseline), and at postoperative days 1 (POD1) and 2.


RESULTS
The hemodynamic parameters were similar in both groups. CrCl during pneumoperitoneum in the diltiazem group was significantly higher than that in the control group (90.8 +/- 49.0 ml/min/1.73 m(2) vs. 54.2 +/- 31.6 ml/min/1.73 m(2)) (P = 0.026). CrCl calculated with Cockcroft-Gault equation was similar in both groups at baseline, POD1, and POD2. Urinary flow was significantly increased in both groups at postoperative 2 h compared with that during pneumoperitoneum.


CONCLUSIONS
Continuous infusion of diltiazem 2 microg/kg/min prevented the decrease in CrCl during pneumoperitoneum without hemodynamic derangement. Although the decrease in CrCl was transient in patients with normal kidney function in this study, diltiazem may be used to prevent further kidney injury in those with elevated CrCl during laparoscopic surgery.
Kim
Ji Young
JY
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Lee
Kyung Cheon
KC
Kim
Hong Soon
HS
Jo
Youn Yi
YY
Kwak
Hyun Jeong
HJ
D000368:Aged; D003404:Creatinine / Q000097:blood; D004110:Diltiazem / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008657:Metabolic Clearance Rate / Q000187:drug effects; D008875:Middle Aged; D009318:Natriuresis / Q000187:drug effects / Q000502:physiology; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*
D003404:Creatinine; D004110:Diltiazem