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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2006

01-09-2006

Carbon dioxide pneumoperitoneum prevents mortality from sepsis

Authors: E. J. Hanly, J. M. Fuentes, A. R. Aurora, S. L. Bachman, A. De Maio, M. R. Marohn, M. A. Talamini

Published in: Surgical Endoscopy | Issue 9/2006

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Abstract

Background

Carbon dioxide (CO2) pneumoperitoneum has been shown to attenuate the inflammatory response after laparoscopy. This study tested the hypothesis that abdominal insufflation with CO2 improves survival in an animal model of sepsis and investigated the associated mechanism.

Methods

The effect of CO2, helium, and air pneumoperitoneum on mortality was studied by inducing sepsis in 143 rats via intravenous injection of lipopolysaccharide (LPS). To test the protective effect of CO2 in the setting of a laparotomy, an additional 65 animals were subjected to CO2 pneumoperitoneum, helium pneumoperitoneum, or the control condition after laparotomy and intraperitoneal LPS injection. The mechanism of CO2 protection was investigated in another 84 animals. Statistical significance was determined via Kaplan– Meier analysis for survival and analysis of variance (ANOVA) for serum cytokines.

Results

Among rats with LPS-induced sepsis, CO2 pneumoperitoneum increased survival to 78%, as compared with using helium pneumoperitoneum (52%; p < 0.05), air pneumoperitoneum (55%; p = 0.09), anesthesia control (50%; p < 0.05), and LPS-only control (42%; p < 0.01). Carbon dioxide insufflation also significantly increased survival over the control condition (85% vs 25%; p < 0.05) among laparotomized septic animals, whereas helium insufflation did not (65% survival). Carbon dioxide insufflation increased plasma interleukin-10 (IL-10) levels by 35% compared with helium pneumoperitoneum (p < 0.05), and by 34% compared with anesthesia control (p < 0.05) 90 min after LPS stimulation. Carbon dioxide pneumoperitoneum resulted in a threefold reduction in tumor necrosis factor-α (TNF-α) compared with helium pneumoperitoneum (p < 0.05), and a sixfold reduction with anesthesia control (p < 0.001).

Conclusion

Abdominal insufflation with CO2, but not helium or air, significantly reduces mortality among animals with LPS-induced sepsis. Furthermore, CO2 pneumoperitoneum rescues animals from abdominal sepsis after a laparotomy. Because IL-10 is known to downregulate TNF-α, the increase in IL-10 and the decrease in TNF-α found among the CO2-insufflated animals in our study provide evidence for a mechanism whereby CO2 pneumoperitoneum reduces mortality via IL-10-mediated downregulation of TNF-α.
Literature
1.
Are C, Talamini MA, Murata K, De Maio A (2002) Carbon dioxide pneumoperitoneum alters acute-phase response induced by lipopolysaccharide. Surg Endosc 16: 1464–1467PubMedCrossRef
2.
Aurora AR, Hanly EJ, Fuentes JM, Marohn MR, De Maio A, Talamini MA (2004) Isoflurane pretreatment increases survival in a rat model of sepsis. J Surg Res 121: 315CrossRef
3.
Bachman SL, Hanly EJ, Nwanko JI, Lamb J, Herring AE, Marohn MR, De Maio A, Talamini MA (2004) The effect of timing of pneumoperitoneum on the inflammatory response. Surg Endosc 18: 1640–1644PubMedCrossRef
4.
Barkun JS, Wexler MJ, Hinchey EJ, Thibeault D, Meakins JL (1995) Laparoscopic versus open inguinal herniorrhaphy: preliminary results of a randomized controlled trial. Surgery 118: 703–710PubMedCrossRef
5.
Borovikova LV, Ivanova S, Zhang M, Yang H, Botchkina GI, Watkins LR, Wang H, Abumrad N, Eaton JW, Tracey KJ (2000) Vagus nerve stimulation attenuates the systemic inflammatory response to endotoxin. Nature 405: 458–462PubMedCrossRef
6.
Buanes T, Mjaland O (1996) Complications in laparoscopic and open cholecystectomy: a prospective comparative trial. Surg Laparosc Endosc Percutan Tech 6: 266–272CrossRef
7.
Casey LC, Balk RA, Bone RC (1993) Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 119: 771–778PubMed
8.
Chang CK, Zdon MJ (2002) Inhibition of tumor necrosis factor-alpha and inducible nitric oxide synthase correlates with the induction of IL-10 in septic rats undergoing laparotomy and laparoscopy. Surg Laparosc Endosc Percutan Tech 12: 247–251PubMedCrossRef
9.
Fuentes JM, Talamini MA, Aurora A, Edwards T, Torres MB, Hanly E, De Maio A (2004) Impairment of LPS-induced cytokine release in anesthetized mice. Shock 21: A17
10.
Fuentes JM, Talamini MA, Hanly EJ, Aurora AR, De Maio A (2004) Dose-dependent anesthesia-mediated attenuation of the inflammatory response. J Surg Res 121: 315CrossRef
11.
Gagné DJ, Malay MJ, Hogle NJ, Fowler DL (2002) Bedside diagnostic minilaparoscopy in the intensive care patient. Surgery 131: 491–496PubMedCrossRef
12.
Glaser F, Sannwald GA, Buhr HJ, Kuntz C, Mayer H, Klee F, Herfarth C (1995) General stress response to conventional and laparoscopic cholecystectomy. Ann Surg 221: 372–380PubMed
13.
Gogos CA, Drosou E, Bassaris HP, Skoutelis A (2000) Pro- versus antiinflammatory cytokine profile in patients with severe sepsis: a marker for prognosis and future therapeutic options. J Infect Dis 181: 176–180PubMedCrossRef
14.
Hanly EJ, Bachman SL, Marohn MR, Boden JH, Herring AE, De Maio A, Talamini MA (2005) CO2-pneumoperitoneum-mediated attenuation of the inflammatory response is independent of systemic acidosis. Surgery 137: 559–566PubMedCrossRef
15.
Hanly EJ, Fuentes JM, Aurora AR, Shih S, Marohn MR, De Maio A, Talamini MA (2005) Abdominal insufflation with CO2 causes peritoneal acidosis independent of systemic pH. J Gastrointest Surg 9: 1245–1252PubMedCrossRef
16.
Hanly EJ, Mendoza-Sagaon M, Murata K, Hardacre JM, De Maio A, Talamini MA (2003) CO2 pneumoperitoneum modifies the inflammatory response to sepsis. Ann Surg 237: 343–350PubMedCrossRef
17.
Howard M, Muchamuel T, Andrade S, Menon S (1993) Interleukin-10 protects mice from lethal endotoxemia. J Exp Med 177: 1205–1208PubMedCrossRef
18.
Jakeways MS, Mitchell V, Hashim IA, Chadwick SJ, Shenkin A, Green CJ, Carli F (1994) Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg 81: 127–131PubMed
19.
Jatzko GR, Lisborg PH, Pertl AM, Stettner HM (1995) Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy. Ann Surg 221: 381–386PubMed
20.
Kelly JJ, Puyana JC, Callery MP, Yood SM, Sandor A, Litwin DE (2000) The feasibility and accuracy of diagnostic laparoscopy in the septic ICU patient. Surg Endosc 14: 617–621PubMedCrossRef
21.
Moore KW, de Waal Malefyt R, Coffman RL, O’Garra A (2001) Interleukin-10 and the interleukin-10 receptor. Annu Rev Immunol 19: 683–765PubMedCrossRef
22.
Mouret P (1996) How I developed laparoscopic cholecystectomy. Ann Acad Med Singapore 25: 744–747PubMed
23.
24.
Rongione AJ, Kusske AM, Ashley SW, Reber HA, McFadden DW (1997) Interleukin-10 prevents early cytokine release in severe intraabdominal infection and sepsis. J Surg Res 70: 107–112PubMedCrossRef
25.
Rongione AJ, Kusske AM, Kwan K, Ashley SW, Reber HA, McFadden DW (2000) Interleukin-10 protects against lethality of intraabdominal infection and sepsis. J Gastrointest Surg 4: 70–76PubMedCrossRef
26.
Tracey KJ, Cerami A (1993) Tumor necrosis factor, other cytokines, and disease. Annu Rev Cell Biol 9: 317–343PubMedCrossRef
27.
Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP (1998) Laparoscopic surgery and the systemic immune response. Ann Surg 227: 326–334PubMedCrossRef
28.
Watkins LR, Goehler LE, Relton JK, Tartaglia N, Silbert L, Martin D, Maier SF (1995) Blockade of interleukin-1-induced hyperthermia by subdiaphragmatic vagotomy: evidence for vagal mediation of immune–brain communication. Neurosci Lett 183: 27–31PubMedCrossRef
29.
West MA, Hackam DJ, Baker J, Rodriguez JL, Bellingham J, Rotstein OD (1997) Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery. Ann Surg 226: 179–190PubMedCrossRef
30.
Yoshidome H, Kato A, Edwards MJ, Lentsch AB (1999) Interleukin-10 suppresses hepatic ischemia/reperfusion injury in mice: implications of a central role for nuclear factor κB. Hepatology 30: 203–208PubMedCrossRef
Metadata
Title
Carbon dioxide pneumoperitoneum prevents mortality from sepsis
Authors
E. J. Hanly
J. M. Fuentes
A. R. Aurora
S. L. Bachman
A. De Maio
M. R. Marohn
M. A. Talamini
Publication date
01-09-2006
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 9/2006
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-005-0246-y

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