Fluid Overload

Intravenous fluid requirements during laparoscopy are less than during open surgery. The combination of decreased insensible losses (no body cavity open to air) and decreased urine output predisposes patients to volume overloading during laparoscopy.

In Clayman's initial nephrectomy series, 2 of the first 10 patients developed transient congestive heart failure, possibly due to excessive intravenous fluid and blood products administration at a time when the decreased urine output during

Despite the well-documented oliguria associated with laparoscopy, acute renal failure following laparoscopy, in the absence of another obvious etiology, is rare.

If acute renal failure does occur after laparoscopy, other etiologies should be evaluated before ascribing this adverse event to the pneumoperitoneum.

laparoscopy was not yet appreciated (173). Similar cases have been reported after other laparoscopic procedures (174). Intraoperative fluid administration should be limited to appropriate replacement for blood loss plus a maintenance rate of 5 mL/kg/hr. Because hypovolemia predisposes patients to adverse hemodynamic effects of pneumoperitoneum, the volume status of the patient should be optimized prior to insufflation.

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