The role of inhaled nitric oxide in protecting the heart in patients with cardiovascular diseases during laparoscopic interventions: a pilot randomized controlled trial

Introduction. Patients with cardiovascular disease undergoing laparoscopic surgery are at high risk of developing various postoperative complications. A significant portion of these complications are due to splanchnic organ hypoperfusion caused by pneumoperitoneum and associated chronic pathological conditions. Despite the demonstrated organ-protective effect of inhaled nitric oxide (iNO) in cardiac surgery, its use in laparoscopic procedures has not been studied.

The objective was to determine whether intraoperative nitric oxide inhalation at a dose of 40 ppm affects cardiac, endothelial, and hemostatic parameters in patients with cardiovascular disease (CVD) requiring laparoscopic abdominal surgery.

Materials and methods. A pilot randomized study was conducted involving 40 patients with CVD undergoing lengthy laparoscopic procedures. In the main group (n = 20), iNO was delivered using an AIT-NO-01 device (Tianox, Russia) at a concentration of 40 ppm with monitoring of nitrogen dioxide (NO₂) and methemoglobin levels. In the control group (n = 20), no additional anesthetic interventions were provided.

Results. iNO at a dose of 40 ppm was well tolerated, with no adverse events recorded; NO₂ concentrations remained below 2 ppm. iNO had a significant effect on glycoprotein 5 concentrations (–4.80 ± 9.02 vs. +0.36 ± 7.05, p = 0.054) and reduced endothelin-1 levels by approximately 70% (+1.05 ± 3.86 vs. +3.47 ± 4.69 pg/ml, p = 0.082), indicating increased endothelial activity. NT-proBNP variability in the iNO group was 86% lower than in the control group. The decrease in end-diastolic volume was 7.9 times greater in the study group (–12.7 vs. –1.6 mL, p = 0.268). In both groups, a statistically significant increase in potassium levels relative to baseline was noted after 24 hours (control: p = 0.019; iNO: p = 0.002).

Conclusion. The use of iNO at a dose of 40 ppm in laparoscopic abdominal surgery appears safe. Complex effects on coagulation factors, the endothelium, cardiac load, and electrolytes were revealed, which justifies conducting large-scale randomized trials to confirm the organ-protective effects.

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