CO2 abdominal insufflation pretreatment increases survival after a lipopolysaccharide-contaminated laparotomy.
Carbon dioxide (CO(2))-pneumoperitoneum is known to favorably modify the systemic immune response during laparoscopic surgery. The presented studies were designed to determine whether treating animals with CO(2) abdominal insufflation before undergoing a lipopolysaccharide (LPS)-contaminated laparotomy would serve as "shock prophylaxis" and thus improve survival and attenuate cytokine production. Rats were randomized into five groups: CO(2)-pneumoperitoneum, helium-pneumoperitoneum, anesthesia control, laparotomy/LPS control, and LPS only control. Animals in the first four groups all received a laparotomy and a lethal dose of LPS. Immediately preceding their laparotomy, animals in the pneumoperitoneum groups received a 30-minute pretreatment of abdominal insufflation with either CO(2) or helium. The anesthesia control group received a 30-minute pretreatment of isoflurane. Animal mortality was then recorded during the ensuing 72 hours. Subsequently, a similar protocol was repeated for measurements of cytokines. CO(2)-pneumoperitoneum increased survival at 48 hours compared with LPS control (P <.05), and decreased interleukin-6 plasma levels at 2 hours (P <.05). Abdominal insufflation with CO(2) before the performance of a laparotomy contaminated with endotoxin increases survival and attenuates interleukin-6. The beneficial immune-modulating effects of CO(2)-pneumoperitoneum endure after abdominal insufflation. CO(2)-pneumoperitoneum pretreatment may improve outcomes among patients undergoing gastrointestinal surgery who are at high risk for abdominal fecal contamination.
Fuentes
Joseph M
JM
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Hanly
Eric J
EJ
Aurora
Alexander R
AR
De Maio
Antonio
A
Shih
Samuel P
SP
Marohn
Michael R
MR
Talamini
Mark A
MA
D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D000818:Animals; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004731:Endotoxins / Q000009:adverse effects; D004926:Escherichia coli; D006371:Helium / Q000008:administration & dosage; D007327:Insufflation / Q000379:methods*; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D007530:Isoflurane / Q000008:administration & dosage; D007813:Laparotomy / Q000009:adverse effects*; D008070:Lipopolysaccharides / Q000009:adverse effects*; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012769:Shock / Q000517:prevention & control; D015996:Survival Rate; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D018685:Anesthetics, Inhalation; D004731:Endotoxins; D015850:Interleukin-6; D008070:Lipopolysaccharides; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002245:Carbon Dioxide; D006371:Helium; C044101:endotoxin, Escherichia coli; D007530:Isoflurane