• Sebastian V Demyttenaere, Ali Taqi, Gerry N Polyhronopoulos, Simon Bergman, Donna D Stanbridge, Bernard Unikowsky, Franco Carli, Gerald M Fried, and Liane S Feldman.
• Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Quebec, Canada.
• Surgery. 2007 Sep 1;142(3):350-6.

BackgroundAlthough aggressive fluid hydration prevents a decrease in renal cortical perfusion (RCP) during laparoscopic donor nephrectomy, excess fluid is deleterious. We assessed whether goal-directed fluid administration, based on hemodynamic measures, would maintain RCP during pneumoperitoneum with less fluid loading.MethodsIn a pilot study of 7 pigs, goal-directed fluid administration was guided by monitoring of stroke volume (SV) by esophageal Doppler measurement. During 15 mmHg CO(2) pneumoperitoneum, a bolus of 5 mL/kg 0.9% NaCl was given when SV decreased to 90% of baseline. Next, 18 pigs were randomized into 3 groups: low fluid (5 mL/kg per hour), high fluid (25 mL/kg per hour) and goal directed. Urine output, heart rate, mean arterial pressure, cardiac output, SV, and RCP were recorded every 15 minutes.ResultsPilot data revealed mean RCP (mL/min per 100 g) was maintained (40 vs 39) during pneumoperitoneum using goal-directed therapy. In the randomized study, RCP was decreased in the low fluid group (43 vs 29; P= .02), but maintained in the high (46 vs 40) and goal-directed (42 vs 39) groups. Mean fluid administered in the goal-directed group during pneumoperitoneum was 10 mL/kg and only 3 of 6 of pigs required boluses. Urine output was decreased in all 3 groups.ConclusionA goal-directed strategy during pneumoperitoneum allows for tailored fluid administration and maintains RCP with lower volumes of intravenous fluid.

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