Effect of warmed, humidified insufflation gas and anti-inflammatory agents on cytokine response to laparoscopic nephrectomy: porcine model.
OBJECTIVE
We evaluated the effects of warmed, humidified CO2 and anti-inflammatory agents on the local and systemic cytokine response after laparoscopic nephrectomy.


METHODS
A total of 15 pigs were randomized to undergo standard laparoscopic nephrectomy, laparoscopic nephrectomy with warmed, humidified CO2 gas or laparoscopic nephrectomy with perioperative administration of intravenous dexamethasone and oral rofecoxib. At baseline, and 1, 4, 24 and 48 hours after surgery duplicate blood and peritoneal samples were drawn to analyze cortisol, glucose, tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta and IL-6 via a microassay technique. Body temperature was determined at operation, intraoperatively and 1 hour postoperatively. Surgical parameters, including operative time, gas volume used and blood loss, were recorded.


RESULTS
Pigs in the warmed, humidified CO2 and anti-inflammatory arms maintained higher intraoperative and postoperative core body temperatures than controls. Warmed, humidified CO2 did not affect peritoneal or systemic cytokine levels. Peak peritoneal TNF-alpha levels in the anti-inflammatory group were significantly higher than in controls at 4 hours. Considerably higher serum TNF-alpha levels in the anti-inflammatory group were observed at 48 hours. Peritoneal IL-1beta and IL-6 levels in the anti-inflammatory group remained similar to those in controls, while serum levels were noticeably lower. There was no observable difference in serum cortisol or the glucose response to laparoscopic nephrectomy among the groups.


CONCLUSIONS
While preserving core body temperature, humidified, warmed CO2 did not affect local or systemic trends of pro-inflammatory mediators. The administration of perioperative anti-inflammatory agents produced conflicting local and systemic cytokine response of uncertain clinical significance.
Margulis
Vitaly
V
Clinical Center for Minimally Invasive Urologic Cancer Treatment, Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Matsumoto
Edward D
ED
Tunc
Lutfi
L
Taylor
Grant
G
Duchenne
David
D
Cadeddu
Jeffrey A
JA
D000818:Animals; D001786:Blood Glucose / Q000032:analysis; D001831:Body Temperature; D002245:Carbon Dioxide; D016207:Cytokines / Q000097:blood*; D005260:Female; D006358:Hot Temperature; D006813:Humidity; D006854:Hydrocortisone / Q000097:blood; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D013552:Swine
D001786:Blood Glucose; D016207:Cytokines; D007375:Interleukin-1; D015850:Interleukin-6; D002245:Carbon Dioxide; D006854:Hydrocortisone