Stepwise rising CO2 insufflation as an ischemic preconditioning method.
BACKGROUND
The pneumoperitoneum (Pp) is associated with ischemia and reperfusion (I/R) injury and oxidative stress. Various ischemic-preconditioning (IP) methods were used to reduce ischemic injury in intra-abdominal organs. In this experimental, randomized, controlled trial with a blind assessment of the outcome, we evaluated the effects of a new IP method, stepwise rising CO(2) insufflation, on oxidative stress and inflammatory cytokine response.


METHODS
Twenty-one rats were divided into three groups. Rats in the control group were subjected to general anesthesia for only 60 minutes. The stepwise group was subjected to 5 mm Hg for 10 minutes, 10 mm Hg for 10 minutes, and 15 mm Hg of CO(2) insufflation for 60 minutes without deflation. In the Pp15 group, the pressure of CO(2) insufflation was fixed at 15 mm Hg for 60 minutes without deflation. Liver and blood samples were examined to determine malondialdehyde (MDA), the antioxidant, superoxide dismutase (SOD), and inflammatory cytokine (tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6]) levels. Histopathologic scores of liver tissue were examined in all groups.


RESULTS
The highest plasma and liver MDA, TNF-alpha, and IL-6 values were in the Pp15 group, followed by the stepwise and control groups. However, plasma and liver SOD levels determined in the control group were significantly higher, compared to stepwise and Pp15 groups. The lowest plasma and liver levels of SOD were in the Pp15 group, followed by the stepwise and control groups. Significantly higher histopathologic scores were found in the Pp15 group, followed by the stepwise and control groups, as well as MDA and inflammatory cytokine (TNF-alpha, IL-6) levels.


CONCLUSIONS
We concluded that the stepwise rising CO(2) insufflation method may be an alternative IP method that may lead to a reduction in I/R injury.
Sahin
Dursun A
DA
Department of General Surgery, Afyonkarahisar Kocatepe University, School of Medicine, Afyonkarahisar, Turkey.
Haliloglu
Berna
B
Sahin
Figen Kir
FK
Akbulut
Gokhan
G
Fidan
Huseyin
H
Koken
Gulengul
G
Buyukbas
Sadik
S
Aktepe
Fatma
F
Arikan
Yuksel
Y
Dilek
Osman Nuri
ON
D000704:Analysis of Variance; D000818:Animals; D002245:Carbon Dioxide; D004797:Enzyme-Linked Immunosorbent Assay; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods; D015850:Interleukin-6 / Q000378:metabolism; D019194:Ischemic Preconditioning / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008099:Liver / Q000098:blood supply* / Q000293:injuries / Q000378:metabolism; D008315:Malondialdehyde / Q000378:metabolism; D018384:Oxidative Stress; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D018709:Statistics, Nonparametric; D013482:Superoxide Dismutase / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002245:Carbon Dioxide; D008315:Malondialdehyde; D013482:Superoxide Dismutase