A method to maintain organ blood flow during laparoscopic surgery has not been developed. Here we determined if
ethyl nitrite, an S-nitrosylating agent that would maintain
nitric oxide bioactivity (the major regulator of tissue perfusion), might be an effective intervention to preserve physiologic status during prolonged
pneumoperitoneum. The study was conducted on appropriately anesthetized adult swine; the period of
pneumoperitoneum was 240 minutes. Cohorts consisted of an
anesthesia control group and groups insufflated with CO2 alone or CO2 containing fixed amounts of
ethyl nitrite (1-300 ppm). Insufflation with CO2 alone produced declines in splanchnic organ blood flows and it reduced circulating levels of
S-nitrosohemoglobin (i.e.,
nitric oxide bioactivity); these reductions were obviated by
ethyl nitrite. In a specific example, preservation of kidney blood flow with
ethyl nitrite kept serum
creatinine and blood
urea nitrogen concentrations constant whereas in the CO2 alone group both increased as kidney blood flow declined. The data indicate
ethyl nitrite can effectively attenuate insufflation-induced decreases in organ blood flow and
nitric oxide bioactivity leading to reductions in markers of acute tissue injury. This simple intervention provides a method for controlling a major source of laparoscopic-related morbidity and mortality: tissue
ischemia and altered postoperative organ function.