title: Comparison of the stress response in patients undergoing gynecological laparoscopic surgery using carbon dioxide pneumoperitoneum or abdominal wall-lifting methods.
abstract: BACKGROUND
  Conventional laparoscopy is aided by CO(2) insufflation, but this may impair cardiorespiratory function, induce stress responses, and result in life-threatening complications. CO(2) insufflation is usually conducted under general anesthesia, whereas gasless laparoscopy supposedly eliminates most of these disadvantages. In this study, we compared the changes of concentration of serum cortisol, tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, IL-10, and heat shock protein 70 (Hsp70) in patients undergoing gynecological laparoscopic surgery in order to explore the severity of the stress response following CO(2) pneumoperitoneum or abdominal wall-lifting methods combined with the different anesthetic techniques performed.
  
  
  METHODS
  Fifty-seven patients scheduled for gynecological laparoscopy from July 2009 to February 2010 with American Society of Anesthesiologists I-II evaluation and scheduled operation times of less than 100 minutes were randomly divided into three groups (GC, GG, or EG) with 20 patients in each group. Group GC patients were operated on with the aid of CO(2) insufflation under general anesthesia. Group GG patients were operated on under general anesthesia using the gasless technique. Group EG patients underwent the same operative procedures under epidural anesthesia using the gasless technique. Serum cortisol, TNF-alpha, IL-6, IL-10, and Hsp70 were detected and analyzed at four time points: Before anesthesia (T(1)), 30 minutes after the beginning of the operation (T(2)), 10 minutes after the end of surgery (T(3)), and at 8:00 a.m. the following day (T(4)).
  
  
  RESULTS
  There were no obvious differences in the levels of serum cortisol, TNF-alpha, IL-6, IL-10, or Hsp70 among the groups at T(1) (P>.05), but these values increased after the beginning of the operation and peaked in Group GC at T(3) and in Group GG and Group EG at T(4). The levels of serum cortisol and TNF-alpha were higher in Group GC than in Group GG at T(2) (P<.05). At T(3), levels of serum cortisol, TNF-alpha, IL-6, and Hsp70 were significantly higher in Group GC than in Group GG (P<.01) and were the same as the changes of IL-6 to IL-10 ratio (P<.05), while serum concentrations of cortisol, TNF-alpha, and IL-6 were also significantly higher in Group GG than in Group EG (P<.05).
  
  
  CONCLUSIONS
  Gynecological laparoscopic surgery using abdominal wall-lifting methods could avoid the deleterious effects of CO(2) pneumoperitoneum, and reduce the stress response. The lowest stress response was found when abdominal wall-lifting methods were used with the patient under epidural anesthesia.
authors.affiliation: Department of Anaesthesiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
authors.forename: Chuanbao
authors.initials: C
authors.lastname: Han
authors.forename: Zhengnian
authors.initials: Z
authors.lastname: Ding
authors.forename: Jin
authors.initials: J
authors.lastname: Fan
authors.forename: Jie
authors.initials: J
authors.lastname: Sun
authors.forename: Yanning
authors.initials: Y
authors.lastname: Qian
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002245:Carbon Dioxide; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D018840:HSP70 Heat-Shock Proteins / Q000097:blood; D006439:Hemodynamics; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007327:Insufflation / Q000009:adverse effects* / Q000379:methods; D015848:Interleukin-5 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D013312:Stress, Physiological / Q000502:physiology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018840:HSP70 Heat-Shock Proteins; D015848:Interleukin-5; D014409:Tumor Necrosis Factor-alpha; D002245:Carbon Dioxide; D006854:Hydrocortisone