Minimally invasive surgeons are performing increasingly complex and time-consuming procedures on increasingly frail patients. Understanding the complex physiologic consequences of pneumoperitoneum is therefore of critical importance. This is especially true in the field of live laparoscopic donor nephrectomy where a thorough understanding of the effects of pneumoperitoneum on renal perfusion and function is mandated. A systematic review of the literature is undertaken and reveals that both renal perfusion and function are decreased during pneumoperitoneum. Next, a porcine model is established and used to compare the effects of aggressive fluid hydration (28cc/kg/h) versus maintenance fluid hydration (5cc/kg/h). We demonstrate that renal perfusion is preserved with aggressive fluid hydration. Finally, a noninvasive fluid administration algorithm based on esophageal Doppler stroke volume measurements is assessed. Using this technique, renal perfusion is preserved during pneumoperitoneum, using less fluid (10cc/kg/h) than a bolus group (25cc/kg/h). Fluid administration via the esophageal Doppler is a noninvasive way to target individual hemodynamics to maintain renal perfusion during pneumoperitoneum.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.97941 |
| Date | January 2006 |
| Creators | Demyttenaere, Sebastian. |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Division of Surgical Research.) |
| Rights | © Sebastian Demyttenaere, 2006 |
| Relation | alephsysno: 002330636, proquestno: AAIMR24655, Theses scanned by UMI/ProQuest. |
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