Renal medullary oxygenation during laparoscopic vs open surgery: the impact of blood pressure management—a pilot randomized controlled trial

Abstract

The impact of blood pressure targets and surgical approach (laparoscopic or open) on continuous urinary oxygenation (PuO 2 ), a validated surrogate of renal medullary PO 2 , during general surgery, is unclear. We aimed to assess the effects of different blood pressure targets and surgical procedures on PuO 2 . MethodsWe randomized patients receiving either laparoscopic or open surgery into two mean arterial pressure (MAP) target groups: usual MAP or a high MAP. We measured PuO 2 in real-time and analyzed it according to the type of surgery and blood pressure target. The study was retrospectively registered on the 5th of July 2023 (ACTRN12623000726651). ResultsWe included 43 participants who underwent either laparoscopic (n = 20) or open surgery (n = 23). We found that PuO 2 signi cantly decreased during both laparoscopic and open surgery under a usual blood pressure target (-51% and − 49%, respectively). However, there was a sharper fall with laparoscopic surgery resulting in a higher PuO 2 with open surgery (mean difference: 11 ± 1 mmHg higher; p < 0.001).Targeting a higher MAP resulted in a higher PuO 2 over time during laparoscopic surgery (mean difference: 7 ± 1 mmHg, p < 0.001). In contrast, targeting a usual MAP resulted in a higher PuO 2 during open surgery (mean difference: 7 ± 1 mmHg, p < 0.001). ConclusionSurgical approach and intraoperative blood pressure targets signi cantly impact urinary oxygenation. Further studies with larger sample sizes are needed to con rm these ndings and understand their potential clinical implications. Implication statementThis study demonstrates that surgical approach and blood pressure targets signi cantly affect urinary oxygenation. A higher blood pressure target during laparoscopic surgery and usual blood pressure during open surgery yielded better oxygenation results, suggesting the need for individualized intraoperative management strategies.