The role of transdermal carbon dioxide on changes in malondialdehyde levels as a marker of ischemia-reperfusion injury in patients with placenta accreta spectrum underwent temporary abdominal aortic cross-clamping as an adjunct procedure during cesarean hysterectomy

Abstract

Background: Temporary abdominal aortic cross-clamping is often applied as an adjunct procedure to control bleeding in patients with placenta accreta spectrum during cesarean hysterectomy. It is claimed to reduce the blood loss need for transfusion and improve visualization of the operating field. After the cross-clamp is removed, the tissue distal to the occlusion, which was initially in an ischemic state, gets a sudden blood flow causing ischemia-reperfusion injury due to the release of ROS. Transdermal administration of carbon dioxide is expected to reduce the release of ROS through the Bohr Effect to protect against ischemia-reperfusion injury, which can be seen from the level of malondialdehyde. Method: This experimental study recruited all patients with placenta accreta spectrum who underwent temporary abdominal aortic cross-clamping during cesarean hysterectomy from January to June 2022. Subjects were divided into control groups and treatment groups. The treatment group was given transdermal CO2 immediately after the aortic cross-clamp was removed. The plasma MDA levels were examined before and after aortic cross-clamping. Results: The number of subjects in each group was 7 subjects. There was an increase in MDA levels from 19.779+0.870nmol/ml to 21.104+1.053nmol/ml after cross-clamp in all groups, with an average increase of 1.325+0.801nmol/ml (p=0.00). The treatment group that received transdermal CO2 had a lower tendency to increase MDA levels, 1.063+0.803nmol/ml, compared to the control group at 1.586+0.766nmol/ml. Conclusion: There was an increase in MDA levels as a predictor of ischemia-reperfusion injury in patients undergoing temporary abdominal aortic cross-clamping. The administration of transdermal CO2 tends to suppress ischemia-reperfusion injury.