The Effect of Intraoperative Fluid Management on Kidney Functions in Laparoscopic Radical Cystectomy

Background: Prolonged pneumoperitoneum in laparoscopic radical cystectomy leads to impairement in organ perfusion especially the kidneys as it decreases renal blood flow and leads to compression on renal parenchyma with release of vasoconstrictors as vasopressin, angiotensin II and catecholeamines leading to decrease in urine output. Aim of the Study: To determine whether intraoperative fluid management could protect kidney functions from hazards of pneumoperitonuem in patients undergoing laparoscopic radical cystectomy operations. Study Design: Randomized controlled trial. Methodology: Eighty patients with cancer bladder scheduled for laparoscopic radical cystectomy, classified by the American Society of Anesthesiologist (ASA) to class (ASAII or ASAIII) were divided into 2 equal groups group I received 2ml/kg/hr LR (Lactated ringer), group II received 8ml/kg/hr LR. Both groups received 8ml/kg LR as a preload. Main Outcome Measures: The primary end point was postoperative serum creatinine concentration. Secondary end points were intraopertive urine output. Results: As regard serum creatinine concentration, on comparing both groups, there was statistically significant difference immediately after desufflation, T1 (0.93±0.33 versus 0.76±0.19) and after 24 hours, T2 (0.85±0.24 versus 0.65±0.17). There was statistical significant difference in urine output between both groups intaoperative after 60 minutes, T2 (59.12±31 versus 78.50±29.7), after 120 minutes, after 180 minutes, T3 (65.12±29.4 versus 83.38±29.2) and after 240 minutes, T4 (61.43±26.7 versus 81±29.4). Conclusion: In patients undergoing laparoscopic radical cystectomy, intraoperative infusion of 8ml/kg/hr Lactated Ringer could prevent the pneumoperitoneum effect on kidney functions and prevent intraoperative oliguria compared to low volume infusion of 2ml/kg/hr Lactated Ringer.