An increased intraabdominal pressure, particularly when occurring during periods of
hemodynamic instability or fluid overload, is regarded as a major contributor to acute
kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures,
intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization
and surgical manipulation but with the potential to compromise net renal perfusion.
Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion
pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately
impacted by venous and lymphatic congestion. At present, the potential risk factors,
mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation
received relatively limited attention among nephrologists and represent an opportunity
to look beyond mere blood pressure and intake-output balances. Careful charting and
reporting duration and extent of surgical pneumoperitoneum represents an opportunity
for anesthesia teams to better communicate intraoperative factors affecting renal
outcomes for the postoperative clinical teams. In this current article, the authors
are integrating preclinical data and clinical experience to provide a better understanding
to optimize renal perfusion during surgeries. Future studies should carefully consider
intrabdominal insufflation pressure as a key variable when assessing outcomes and
blood pressure goals in these settings.
