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PuO2 as a marker for renal blood flow in laparoscopic versus open donor nephrectomy: A-71

zur Borg, Mertens I.; Roubos, S.; IJzermans, J.; Klein, J.

European Journal of Anaesthesiology: May 2005 - Volume 22 - Issue - p 19
Monitoring: Equipment and Computers
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Department of Anaesthesiology, Erasmus UMC, Rotterdam, Rotterdam, The Netherlands

Background and Goal of Study: Laparoscopic donor nephrectomie (LDN) is performed more often because of reduced postoperative morbidity and shorter hospital stay. Animal studies have shown however a reduced renal blood flow (RBF) during pneumoperitoneum [1]. To measure RBF, invasive techniques should be used, however earlier investigators suggested that urine oxygen tension (PuO2) is related to renal medullar blood flow (RmBF) [2]. This study is the first prospective randomised study where RBF is measured and comparing LDN and open donor nephrectomy (ODN) patients.

Materials and Methods: 32 patients in the LDN en 33 in the ODN group, were included. Anaesthesia was performed with a fixed protocol and continuos FiO2 of 40%. High dosage of morfomimetica and liberate fluid regime of colloids and crystalloids starting before operation was used. PuO2 samples were obtained on 2 moments.

Results and Discussions: 9 patients from the ODN and 3 patients from the LDN group had to be excluded. Both operation techniques cause an equivalent and a significant (p < 0.05) increase in PuO2 after two hours of operation. No difference is found in PuO2 between LDN and ODN.

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Conclusion(s): We concluded that provided there is an adequate anaesthesia technique with liberate fluid supply and IAP is maintained at 12 mmHg, the intra operative RmBF is not dependent on surgical procedure. The increase in PuO2 during surgery can be explained by redistribution of the RBF in the kidney from cortex to medulla.

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References:

1 Cisek LJ, Gobet RM, Peters CA, Journal of Endourology. 1998; 12(2): 95-100.
2 Kainuma M, Kimura N, Shimada Y, Crit Care Med. 1990; 18(3): 309-12.
© 2005 European Society of Anaesthesiology