An Individualized Low-Pneumoperitoneum-Pressure Strategy May Prevent a Reduction in Liver Perfusion during Colorectal Laparoscopic Surgery

Author:

Olmedilla Arnal Luis Enrique1,Cambronero Oscar Diaz234,Mazzinari Guido235ORCID,Pérez Peña José María1,Zorrilla Ortúzar Jaime1ORCID,Rodríguez Martín Marcos6,Vila Montañes Maria23,Schultz Marcus J.789ORCID,Rovira Lucas10ORCID,Argente Navarro Maria Pilar23,

Affiliation:

1. Department of Anaesthesiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain

2. Perioperative Medicine Research Group, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain

3. Department of Anaesthesiology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain

4. Spanish Clinical Research Network (SCReN), SCReN-IIS La Fe, PT17/0017/0035, 46026 Valencia, Spain

5. Department of Statistics and Operations Research, University of Valencia, 46100 Valencia, Spain

6. Department of Digestive Surgery, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain

7. Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Amsterdam University Medical Centers, Location ‘AMC’, 1105 AZ Amsterdam, The Netherlands

8. Mahidol Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand

9. Nuffield Department of Medicine, University of Oxford, Oxford OX3 7BN, UK

10. Department of Anaesthesiology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain

Abstract

High intra-abdominal pressure (IAP) during laparoscopic surgery is associated with reduced splanchnic blood flow. It is uncertain whether a low IAP prevents this reduction. We assessed the effect of an individualized low-pneumoperitoneum-pressure strategy on liver perfusion. This was a single-center substudy of the multicenter ‘Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy II study’ (IPPCollapse–II), a randomized clinical trial in which patients received an individualized low-pneumoperitoneum strategy (IPP) or a standard pneumoperitoneum strategy (SPP). Liver perfusion was indirectly assessed by the indocyanine green plasma disappearance rate (ICG–PDR) and the secondary endpoint was ICG retention rate after 15 min (R15) using pulse spectrophotometry. Multivariable beta regression was used to assess the association between group assignment and ICG–PDR and ICG–R15. All 29 patients from the participating center were included. Median IAP was 8 (25th–75th percentile: 8–10) versus 12 (12,12) mmHg, in IPP and SPP patients, respectively (p < 0.001). ICG–PDR was higher (OR 1.42, 95%-CI 1.10–1.82; p = 0.006) and PDR–R15 was lower in IPP patients compared with SPP patients (OR 0.46, 95%-CI 0.29–0.73; p = 0.001). During laparoscopic colorectal surgery, an individualized low pneumoperitoneum may prevent a reduction in liver perfusion.

Funder

Merck Sharp & Dohme

Publisher

MDPI AG

Subject

General Biochemistry, Genetics and Molecular Biology,Medicine (miscellaneous)

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