The role of ischemia modified albumin in the evaluation of hemodynamic changes in the splanchnic area during laparoscopic cholecystectomy

Abstract

Purpose: Elevation of intraabdominal pressure by means of gas insufflation produces hemodynamic disturbances in the peritoneal viscera, leading to splanchnic ischemia. Recently, ischemia modified albumin (IMA) has been used to investigate conditions such as myocardial and skeletal muscle ischemia. The purpose of this clinical investigation is to determine the role of IMA in the evaluation of alterations in blood flow of the splanchnic area and abdominal viscera during laparoscopic cholecystectomy.

Patients and Methods: Twenty two patients (F/M: 21/1) undergoing laparoscopic cholecystectomy (Group I) and 10 patients (F/M: 7/3) undergoing various surgical procedures under general anestheasia (Group II) were studied. No patient had any cardiovascular disease. Blood samples for IMA were collected at preoperative and intraoperative periods. A rapid, colorimetric assay was used to measure serum IMA levels.

Results: In Group I, the preoperative and intraoperative IMA levels were 0.59±0.16 absorbance units (ABSU) and 0.74±0.17 ABSU respectively. The intraoperative IMA levels were higher than the preoperative levels (p=0.025). In Group II, the preoperative and intraoperative IMA levels were 0.43±0.12 ABSU and 0.52±0.15 ABSU respectively. The difference was not statistically significant (p=0.22). The intraoperative IMA levels in Group I were higher than Group II (p=0.003).

Conclusion: IMA, a new sensitive marker for ischemia, can be helpful for determining alterations in blood flow of the splanchnic area and abdominal viscera during laparoscopic cholecystectomy.