Gastrointestinal tract protection with nitric oxide inhalation during laparoscopic interventions: a pilot study

Introduction. Intra-abdominal hypertension always accompanies laparoscopic surgeries, causes ischemia of the gastrointestinal mucosa with possible subsequent development of organ dysfunction.

The objective was to study the effect of inhaled nitric oxide on the development of postoperative complications in patients with cardiovascular pathology who underwent intervention on the abdominal organs under conditions of prolonged carboxyperitoneum.

Materials and methods. A pilot prospective randomized study included 40 patients suffering from cardiovascular pathology who underwent prolonged laparoscopic intervention on the abdominal organs. The main group consisted of 20 patients, who were given inhalation of nitric oxide using the AIT-NO-01 device (Tianox, RFNC-VNIIEF, Russia) at a dose of 40 ppm during entire surgery under the control of the level of nitrogen dioxide and methemoglobin. In the comparison group (n = 20), standard surgical support was provided.

Results. The duration of the surgery in the main group was 240 [145; 258] minutes, in the comparison group – 230 [165; 270] minutes, p = 0.405. The length of stay in hospital was 11 [8–13] days in the main group, and 14 [10.5–21.0] days in the comparison group, p = 0.010. In patients of the main group, according to auscultation and ultrasound examination, intestinal peristalsis was restored earlier than in patients of the comparison group. According to laboratory data, significant differences were found in the levels of nitric oxide, which was higher in the main group (14 [11–20] vs 8 [6–9] nmol/ml, p = 0.0001), the level of intestinal wall damage markers in the main group was significantly lower (intestinal fatty acid binding protein (0.130 [0.104–0.209] vs 0.203 [0.146–0.495] ng/ml, p = 0.015) and bacterial lipopolysaccharide binding protein (10.0 [7.40–28.16] vs 18.31 [12.09–24.12] ng/ml, p = 0.044)), and the levels of vasoconstrictor endothelin-1 were also lower in the main group (5.79 [4.35–12.64] vs 13.41 [5.71–21.27] pg/ml, p = 0.041) and the nitric oxide synthase enzyme inhibitor – asymmetric dimethylarginine (59.5 [51.7–72.8] vs 83.1 [69.1–99.1] ng/ml, p = 0.001).

Conclusions. Intraoperative inhalation of nitric oxide in patients with cardiovascular pathology has an intestinal protective effect (judging by clinical signs, laboratory and instrumental data) after long-term laparoscopic interventions, reduces the severity of vasoconstriction and reduces the length of stay in hospital.

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