Preconditioning is a method that may reduce the negative side-effect of pneumoperitoneum

Abstract

Increased intra-abdominal pressure during laparoscopy leads to hypoxia due to reduced blood flow. Aim of our study was to investigate whether preconditioning can reduce this negative effect of the pneumoperitoneum. Fifty female Wistar rats were used, divided into 5 groups. I: Sham operation (Sham), II: conventional pneumoperitoneum (PP), III: transvaginal pneumoperitoneum (TV), IV: preconditioning for 2.5 minutes in two cycles (Pre 2.5), V: preconditioning for 5 minutes (Pre 5). Malondialdehyde (MDA), reduced glutathione (GSH), sulfhydrylgroup (SH-) concentrations, superoxide-dismutase (SOD) and mieloperoxidase (MPO) activity, and anti-apoptotic pathway marker p-AKT level and inflammatory cytokine TNF-α were measured. SOD activity and GSH concentration were decreased in PP and TV groups comparing to Sham and preconditioning groups. MPO activity was decreased also in PP and TV groups comparing to the Sham group but in the preconditioning groups it has remained high. MDA concentration in plasma was increased in PP and TV groups comparing to Sham and preconditioning groups. There was no difference in the case of blood MDA and SH-concentrations between groups. Anti-apoptotic pathway marker p-AKT level was decreased in the TV group comparing to the sham and preconditioning groups. TNF-α level was increased in TV and preconditioning groups compared to the sham group. According to the results preconditioning can reduce negative effects of pneumoperitoneum.

Protective effects of postconditioning in transvaginally created pneumoperitoneum

“…In our experiments, we created pneumoperitoneum conditions using a transvaginal approach due to the advantages of NOTES (Natural Orifice Transluminal Endoscopic Surgery) procedures, which are associated with less traumatic stress (14,23). Simultaneously, however, we wanted to achieve substantial oxidative stress, and therefore stressful levels of pneumoperitoneum pressure were applied (10 mmHg) (24,25).…”

“…Recently authors reported the effect of a 10-min ischemia postconditioning regimen (with 5 min of each-desufflation and insufflation), after pneumoperitoneum (7). The effect of postconditioning was evaluated by blood level analysis of oxidative stress markers and assessment of tissue morphology in animal models, which were initially established by our group (14). In the present study, we used a similar animal model and comparatively assessed two 10-min postconditioning regimens: a) Desufflation/insufflation for 5 min each; b) desufflation/insufflation for 2.5 min each-repeated twice (2 cycles).…”

Mediators of Regional Kidney Perfusion during Surgical Pneumo-Peritoneum Creation and the Risk of Acute Kidney Injury—A Review of Basic Physiology

“…Superoxide-dismutase activity was higher in sham-operated rats than in rats with pneumo-peritoneum of 15 mmHg. The activity of protective enzymes can be stimulated by ischemic pre- or post-conditioning [ 133 , 134 ]. Both two cycles of a 2.5-min insufflation and a single cycle of 5 min increased the activities of superoxide-dismutase, myeloperoxidase, and attenuated the rise of malondialdehyde (marker of lipid peroxidation) after a 60-min pneumo-peritoneum of 10 mmHg in rats [ 133 , 135 ].…”

“…The activity of protective enzymes can be stimulated by ischemic pre- or post-conditioning [ 133 , 134 ]. Both two cycles of a 2.5-min insufflation and a single cycle of 5 min increased the activities of superoxide-dismutase, myeloperoxidase, and attenuated the rise of malondialdehyde (marker of lipid peroxidation) after a 60-min pneumo-peritoneum of 10 mmHg in rats [ 133 , 135 ]. Parallel to these changes, no effect was detected on the inflammatory-response-associated tumor necrosis factor α (TNF-α) levels.…”

Η Επίδραση Του Αντι TNF-α Στη Σπλαγχνική Ισχαιμία-Επαναιμάτωση Από Πνευμοπεριτόναιο

“…Μικρότερου βαθμού ήταν και οι ιστικές βλάβες που παρατηρήθηκαν μετά από ισχαιμική προετοιμασία, με πιο εμφανή αποτελέσματα στο ήπαρ. Η προστασία δε που προσφέρει είναι τόσο σημαντική που πολλά από τα αποτελέσματα δεν είχαν στατιστικώς σημαντικές διαφορές με την ομάδα ελέγχου (ομάδα S), όπως είναι οι ιστικές βλάβες στο ήπαρ και στο έντερο, τα αποτελέσματα της αναγωγάσης της γλουταθειόνης και της μυελουπεροξειδάσης του ορού.Τα αποτελέσματα της μελέτης μας είναι αντίστοιχα άλλων προηγούμενων πειραματικών μελετών με ισχαιμική προετοιμασία σε πνευμοπεριτόναιο358,442,443 . 25% επίμυος) μονοκλωνικό IG1 αντίσωμα εναντίων του TNF-α, κατασκευασμένο με τεχνικές ανασυνδυασμού, έχει υψηλή συνάφεια με διαλυτά μόρια TNF-α και με τους μεμβρανικούς υποδοχείς του6 .…”