Efficacy of total intravenous anesthesia (TIVA) in blocking the elevation of NGAL in perioperative laparoscopic bariatric surgery

Abstract

The lipocalin-2 (NGAL) has recently emerged as an early marker, sensitivity and specificity of renal function in some clinical and surgical (1), especially nephropathy post cardiac surgery and use of radiological iodinated contrast. (2) (3) in the obese it is high, this increase is directly related to inflammation in obesity, type 2 diabetes, insulin resistance, dyslipidemia and hypertension, as well as elevation of cytokines (IL1, IL6, TNF ) and is therefore a marker of systemic inflammatory response, (4) many stimuli may increase the Ngal including interleukin-1. (5) The NGAL as well as interleukins, rise after surgical trauma (6), even those who do not develop renal damage. Several cut-off levels have been suggested for the association of this marker with renal damage, depending on the clinical situation and the intensity of trauma response triggered, the cutoff for good association with renal injury varies from 25 to 550ng/ml. (1) The variation of Ngal has not been studied in the perioperative period of laparoscopic bariatric surgery, or even what magnitude of increase is associated with decreased urine output and creatinine clearance. Within this type of surgery some degree of suffering kidney damage is expected due to pneumoperitoneum, together with the inflammatory response to trauma, is expected to rise in NGAL after surgical trauma. The literature says no improvement in clinical outcomes related to quality and safety of total intravenous anesthesia (TIVA) for inhalation anesthesia. TIVA has been associated with better control of the inflammatory response, manifested by an increase of anti-inflammatories such as IL10 (7) and better control of stress hormones such as noradrenaline, adrenaline, cortisol, GH, prolactin and ACTH. (8) We assume that total intravenous anesthesia with propofol promote a smaller increase of NGAL, as this type of anesthesia has been associated with better control pro inflammatory mediators which in turn can raise the plasma NGAL. (5) (AU)