title: Evidence for negative effects of elevated intra-abdominal pressure on pulmonary mechanics and oxidative stress.
abstract: OBJECTIVE
  To compare the effects of pneumoperitoneum on lung mechanics, end-tidal CO2 (ETCO2), arterial blood gases (ABG), and oxidative stress markers in blood and bronchoalveolar lavage fluid (BALF) during laparoscopic cholecystectomy (LC) by using lung-protective ventilation strategy.
  
  
  METHODS
  Forty-six patients undergoing LC and abdominal wall hernia (AWH) surgery were assigned into 2 groups. Measurements and blood samples were obtained before, during pneumoperitoneum, and at the end of surgery. BALF samples were obtained after anesthesia induction and at the end of surgery.
  
  
  RESULTS
  Peak inspiratory pressure, ETCO2, and pCO2 values at the 30th minute were significantly increased, while there was a significant decrease in dynamic lung compliance, pH, and pO2 values in LC group. In BALF samples, total oxidant status (TOS), arylesterase, paraoxonase, and malondialdehyde levels were significantly increased; the glutathione peroxidase levels were significantly decreased in LC group. The serum levels of TOS and paraoxonase were significantly higher at the end of surgery in LC group. In addition, arylesterase level in the 30th minute was increased compared to baseline. Serum paraoxonase level at the end of surgery was significantly increased when compared to AWH group.
  
  
  CONCLUSIONS
  Our study showed negative effects of pneumoperitoneum in both lung and systemic levels despite lung-protective ventilation strategy.
authors: Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: I
authors: I
authors: Davarcı
authors: Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: M
authors: M
authors: Karcıoğlu
authors: Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: K
authors: K
authors: Tuzcu
authors: Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: K
authors: K
authors: İnanoğlu
authors: Department of Thoracic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: T D
authors: TD
authors: Yetim
authors: Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: S
authors: S
authors: Motor
authors: Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: K T
authors: KT
authors: Ulutaş
authors: Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
authors: R
authors: R
authors: Yüksel
mesh_terms: D000328:Adult; D043303:Aryldialkylphosphatase / Q000378:metabolism; D001784:Blood Gas Analysis; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002265:Carboxylic Ester Hydrolases / Q000378:metabolism; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005260:Female; D005979:Glutathione Peroxidase / Q000378:metabolism; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000032:analysis; D018384:Oxidative Stress / Q000502:physiology*; D011027:Pneumoperitoneum / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000502:physiology*
chemical_list: D008315:Malondialdehyde; D005979:Glutathione Peroxidase; D002265:Carboxylic Ester Hydrolases; C019734:arylesterase; D043303:Aryldialkylphosphatase