T.V Challenge to Predict Early Post- Operative Acute Kidney Injury and Intra-operative Hypotension in Laparoscopic Abdominal Surgeries
Condition: Tidel Volume Challenge Test
MeSH terms: Acute Kidney Injury; Hypotension
Study type: Observational

Summary: 
      The purpose of study is to verify the predictability of TV Chalange test during laparoscopic
      abdominal surgery for early postoperative AKI and intra-operative hypotension.

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Detailed description: 
      The number and scope of laparoscopic surgery are increasing. Now almost every abdominal organ
      seems suitable for laparoscopic surgery. Laparoscopy may be considered potentially risky
      because it may involve extreme changes in the patient's position, prolonged intra-abdominal
      insufflation and carbon dioxide (CO2) degassing, unexpected visceral damage, and difficulty
      in assessing blood loss. The anesthesiologist must select the appropriate anesthesia
      management technique, conduct proper monitoring, and be aware of potential complications.
      Early detection and reduction of possible intra-operative problems can prevent postoperative
      complications and early complications.

      Laparoscopic injection of CO2 or N2O can cause cardiovascular depression . Insufflation at a
      high flow rate can also exacerbate cardiovascular sequelae, including hypotension and
      bradycardia, and cause cardiac arrest . Intra-operative hypotension caused by rapid
      laparoscopic inflation is caused by the vagal-mediated cardiovascular reflex caused by the
      rapid expansion of the peritoneum. It can also be attributed to the reduction in preload and
      venous return associated with the pneumo-peritoneum (PP) .

      During the period of elevated intra-abdominal pressure, there are three different mechanisms
      of renal insufficiency, including hypercapnia caused by CO2 insufflation, elevated
      intra-abdominal pressure and renin-angiotensin-aldosterone system (RAAS) .

      In another study, the incidence of AKI after laparoscopic abdominal surgery was 35.9%, which
      was higher than the previous study .

      Patients with low-volume status are susceptible to AKI due to ischemic acute tubular necrosis
      due to renal insufficiency, and predisposed by hypotension as a pre-renal cause.

      Although low volume status has a major role in post-operative AKI .Yet, there are rising
      theories explaining the increased incidence of AKI in patients undergoing laparoscopic
      surgeries to increased renal resistive index (RRI) by increased intra-abdominal pressure
      Intra-operative volume status indicators are variable, including inferior vena cava (IVC),
      carotid artery ratio (JCR), stroke volume change (SVV) and pulse pressure change (PPV). These
      indicators may be reliable, but complex, time-consuming, and require trained personnel and
      high-tech equipment .

      The Tidal Volume Challenge (TVC) test is a new tool which is used to assess the volume status
      and it has been approved as a reliable tool in neurosurgery patients . However, as far as we
      know, it has not been used to predict hypotension and AKI in laparoscopic surgeries. We
      hypothesis that mimicking the effect of increased intra-abdominal pressure transiently for a
      short period of time by TVC test could contribute in detecting patients at high risk of
      developing post-operative AKI.

      TVC test/ abdominal insufflation adverse consequences can be also explained mainly by reduced
      venous compliance in some patients leading to mobilization of blood to peripheral venous
      system, with reduced venous elasticity the passive blood recoil to the heart maintaining
      hemo-dynamic stability and organ perfusion will be diminished, aggravating the effect of
      increased intra-abdominal or intra-thoracic pressure. That mechanism has been studied in
      orthostatic hypotension The purpose of study is to verify the predictability of TVC test
      during laparoscopic abdominal surgery for early postoperative AKI and intra-operative
      hypotension.

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Intervention name(s): Tidal volume challenge test
Intervention type(s): Diagnostic Test
Intervention description(s): The purpose of our study is to verify the predictability of TVC test during laparoscopic abdominal surgery for early postoperative AKI and intra-operative hypotension.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The study will be conducted in Kasr Alainy Hospital of Cairo University.