Carbon dioxide pneumoperitoneum–mediated attenuation of the inflammatory response is independent of systemic acidosis

Hanly, Eric J.; Bachman, Sharon L.; Marohn, Michael R.; Boden, John; Herring, A. E.; Maio, Antonio De; Talamini, Mark A.

doi:10.1016/j.surg.2005.01.005

Cited by 32 publications

(14 citation statements)

References 32 publications

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“…These data include basic scientific evidence that insufflation with CO 2 blunts the hepatic expression of acute phase genes in multiple models of perioperative sepsis [1,14,16], and clinical evidence that the release of inflammatory mediators is less after laparoscopy than after conventional open surgery [18,27]. These data are consistent with the findings that patients subjected to laparoscopy generally experience less postoperative pain, shorter postoperative ileus, shorter hospital stays, and a more rapid return to preoperative activity than their laparotomized counterparts [4,6,12,19].…”

supporting

confidence: 66%

“…Carbon dioxide is quickly absorbed by the peritoneum, and has the opportunity to affect cytokine production by altering the function of peritoneal macrophages and/or Kupffer cells (via ''communication'' through the portal system), possibly via local acidification of the peritoneal environment. We have recently shown that abdominal insufflation with CO 2 does cause local peritoneal acidosis without affecting systemic acid-base status in properly ventilated animals [14,15]. Furthermore, it has been shown that murine peritoneal macrophages derived from peritoneal cavities insufflated with CO 2 release less TNF-a in response to in vitro LPS stimulation than cells derived from animals insufflated with helium or air [29].…”

Section: Discussionmentioning

confidence: 99%

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Carbon dioxide pneumoperitoneum prevents mortality from sepsis

et al. 2006

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Abdominal insufflation with CO2, but not helium or air, significantly reduces mortality among animals with LPS-induced sepsis. Furthermore, CO2 pneumoperitoneum rescues animals from abdominal sepsis after a laparotomy. Because IL-10 is known to downregulate TNF-alpha, the increase in IL-10 and the decrease in TNF-alpha found among the CO2-insufflated animals in our study provide evidence for a mechanism whereby CO2 pneumoperitoneum reduces mortality via IL-10-mediated downregulation of TNF-alpha.

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supporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Carbon dioxide pneumoperitoneum prevents mortality from sepsis

et al. 2006

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“…Researches focused on inflammatory responses after laparoscopic surgery involve not only general but also focal responses. Due to the insufflation of CO 2 , the pH value is suppressed focally in the operative field, [4][5][6] but not in general system. The acid circumstances can than lead to focal immune suppression and reduce inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Effect of Endoscopic Thyroidectomy via Anterior Chest Wall Approach on Treatment of Benign Thyroid Tumors

Wang¹,

Zhang²,

Mao³

et al. 2008

WJOLS

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Objective: To evaluate the inflammatory response and acid-base equilibrium index, as well as other clinical facts of the endoscopic thyroidectomy via the anterior chest wall approach.Methods: 39 patients who received thyroidectomy in our surgical center during September 2007 and January 2008 were included in this study. Twenty of the patients underwent an endoscopic surgery, and the rest 19 received a conventional surgery. These patients' data were compared within and between treatment groups with respect to clinical facts and inflammatory evaluations. Arterial blood gas data and electrolyte data were analyzed within the endoscopic group.Results: Endoscopic thyroidectomy group showed shorter operative time compared to that of conventional thyroidectomy group, although the difference didn't reach statistical significance. No significant difference regarding postoperative hospital stay was observed between two groups. Postoperative day 1 shows much higher values of IL-6 and TNF than that measured preoperative or postoperative day 3 in both groups. CRP appeared to be significantly increased postoperatively in both groups, although no difference between the two groups was found. Although blood cortisol significantly increased in both groups postoperatively, the data of endoscopic group postoperative day 1 was lower than the same day of conventional group. Arterial blood gas analysis showed that both PCO 2 and TCO 2 were statistically different between preoperation and 30 min after insufflation. No insufflation complication was observed. Conclusion:Compared with conventional thyroid surgery, endoscopic thyroidectomy via anterior chest wall approach presented with no significant difference in respect of both clinical facts and laboratory outcomes.

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“…Experimental model -Several animal models of peritoneal sepsis have been described varying in many respects, including the specific animal utilized and the method of sepsis 20,23,24,25 . The model of creating sepsis used in this study was adapted from the work of Hanly et al 26 .…”

Section: Discussionmentioning

confidence: 99%

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

et al. 2006

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Purpose: Laparoscopic surgery is associated with reduced surgical trauma, and less acute phase response, as compared with open surgery. Cytokines are important regulators of the biological response to surgical and anesthetic stress. The aim of this study was to determine if CO 2 pneumoperitoneum would change cytokine expression, gas parameters and leukocyte count in septic rats. Methods: Wistar rats were randomly assigned to five groups: control (anesthesia only), laparotomy, CO 2 pneumoperitoneum, cecum ligation and puncture by laparotomy, and laparoscopic cecum ligation and puncture. After 30 min of the procedures, arterial blood samples were obtained to determine leukocytes subpopulations by hemocytometer. TNFα, IL-1β, IL-6 were determined in intraperitoneal fluid (by ELISA). Gas parameters were measured on arterial blood, intraperitoneal and subperitoneal exsudates. Results: Peritoneal TNFα, IL-1β and IL-6 concentrations were lower in pneumoperitoneum rats than in all other groups (p<0.05). TNFα, IL-1β and IL-6 expression was lower in the laparoscopic than in laparotomic sepsis (p<0.05). Rats from laparoscopic cecum ligation and puncture group developed significant hypercarbic acidosis in blood and subperitoneal fluid when compared to open procedure group. Total white blood cells and lymphocytes were significantly lower in laparoscopic cecum ligation and puncture rats than in the laparotomic (p<0.01). Nevertheless, the laparotomic cecum ligation rats had a significant increase in blood neutrophils and eosinophils when compared with controls (p<0.05). Conclusions: This study demonstrates that the CO 2 pneumoperitoneum reduced the inflammatory response in an animal model of peritonitis with respect to intraperitoneal cytokines, white blood cell count and clinical correlates of sepsis. The pneumoperitoneum produced hypercarbic acidosis in septic animals. Key words: Pneumoperitoneum. Carbon Dioxide. Sepsis. Acidosis. Leucocytes. RESUMO Objetivo:A cirurgia laparoscópica está associada com trauma reduzido e baixa resposta na fase aguda do trauma, quando comparada com a cirurgia aberta. As citocinas e o balanço ácido-base são fatores importantes da resposta biológica ao trauma cirúrgico-anestésico. O objetivo deste estudo foi determinar se o pneumoperitôneo com CO 2 altera a expressão das citocinas, a gasometria e a contagem diferencial de leucócitos em ratos com sepse abdominal. Métodos: Ratos Wistar foram aleatoriamente distribuídos em 5 grupos: controle (somente anestesia), laparotomia, pneumoperitôneo com CO 2 , ligadura e punção do ceco por laparotomia, ligadura e punção do ceco por laparoscopia. Após 30 minutos dos procedimentos, sangue arterial foi colhido para leucometria diferencial em hemocitômetro. TNFα, IL-1β e IL-6 foram dosadas no líquido intraperitoneal (por ELISA). Os parâmetros gasosos foram medidos no sangue arterial e nos exsudatos intraperitoneal e subperitoneal. Resultados: Os valores de TNFα, IL-1β e IL-6 foram significantemente menores nos ratos submetidos ao pneumoperitôneo do que em...

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Carbon dioxide pneumoperitoneum–mediated attenuation of the inflammatory response is independent of systemic acidosis

Cited by 32 publications

References 32 publications

Carbon dioxide pneumoperitoneum prevents mortality from sepsis

Carbon dioxide pneumoperitoneum prevents mortality from sepsis

Effect of Endoscopic Thyroidectomy via Anterior Chest Wall Approach on Treatment of Benign Thyroid Tumors

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

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