A method to attenuate pneumoperitoneum-induced reductions in splanchnic blood flow

Nishath Athar Ali, W. Steve Eubanks, Jonathan S. Stamler, Andrew J. Gow, Sandhya A. Lagoo-Deenadayalan, Leonardo Villegas, Habib E. El-Moalem, James D. Reynolds

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


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. Summary Background Data: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)256-261
Number of pages6
JournalAnnals of surgery
Issue number2
StatePublished - Feb 2005
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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