Abstract
Background Infants are likely to develop anuria during laparoscopy which is uncommon in older
patients. The reason for this susceptibility remains unknown. We compared the impact
of CO2 pneumoperitoneum on renal perfusion and urine production in piglets compared with
adolescent pigs. We furthermore investigated the effects of different resuscitation
strategies.
Materials and Methods Male piglets (n = 21) were divided into four groups: (a) infant controls (n = 5), (b) infants with crystalloid restitution (n = 6), (c) infants with colloidal restitution (n = 5), and (d) adolescents with crystalloid restitution (n = 5). Animals were ventilated, the central vessels and ureters were cannulated, and
the animals were subjected to a 3-hour, 10 mm Hg CO2 pneumoperitoneum followed by 2-hour resuscitation. Renal perfusion was assessed by
fluorescent microspheres and the rate of urine flow was measured.
Results Urine production significantly decreased after insufflation only in the infant crystalloid
and adolescent group, but not in controls or infants treated with colloids. In the
infant crystalloid group, urine production remained at levels below 20% of baseline
throughout the experiment. In this group, the renal perfusion dropped significantly
after the beginning of the capnoperitoneum and remained significantly reduced throughout
the experiment.
Conclusion Our data indicates that capnoperitoneum impairs renal perfusion and urine production
in infants. In moderate-pressure capnoperitoneum, this effect cannot be compensated
by application of crystalloids but with colloids.
Keywords
neonatal - pneumoperitoneum - renal perfusion - laparoscopy - hepatorenal reflex
