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Abstract
An increased intraabdominal pressure, particularly when occurring during periods of hemodynamic instability or fluid overload, is regarded as a major contributor to acute kidney injury (AKI) in intensive care units. During abdominal laparoscopic procedures, intraoperative insufflation pressures up to 15 mmHg are applied, to enable visualization and surgical manipulation but with the potential to compromise net renal perfusion. Despite the widely acknowledged renal arterial autoregulation, net arterial perfusion pressure is known to be narrow, and the effective renal medullary perfusion is disproportionately impacted by venous and lymphatic congestion. At present, the potential risk factors, mitigators and risk-stratification of AKI during surgical pneumoperitoneum formation received relatively limited attention among nephrologists and represent an opportunity to look beyond mere blood pressure and intake-output balances. Careful charting and reporting duration and extent of surgical pneumoperitoneum represents an opportunity for anesthesia teams to better communicate intraoperative factors affecting renal outcomes for the postoperative clinical teams. In this current article, the authors are integrating preclinical data and clinical experience to provide a better understanding to optimize renal perfusion during surgeries. Future studies should carefully consider intrabdominal insufflation pressure as a key variable when assessing outcomes and blood pressure goals in these settings.
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Hydromorphone Protects against CO 2 Pneumoperitoneum-Induced Lung Injury via Heme Oxygenase-1-Regulated Mitochondrial Dynamics. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:9034376. [PMID: 33927798 PMCID: PMC8053056 DOI: 10.1155/2021/9034376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/01/2023]
Abstract
Various pharmacological agents and protective methods have been shown to reverse pneumoperitoneum-related lung injury, but identifying the best strategy is challenging. Herein, we employed lung tissues and blood samples from C57BL/6 mice with pneumoperitoneum-induced lung injury and blood samples from patients who received laparoscopic gynecological surgery to investigate the therapeutic role of hydromorphone in pneumoperitoneum-induced lung injury along with the underlying mechanism. We found that pretreatment with hydromorphone alleviated lung injury in mice that underwent CO2 insufflation, decreased the levels of myeloperoxidase (MPO), total oxidant status (TOS), and oxidative stress index (OSI), and increased total antioxidant status (TAS). In addition, after pretreatment with hydromorphone, upregulated HO-1 protein expression, reduced mitochondrial DNA content, and improved mitochondrial morphology and dynamics were observed in mice subjected to pneumoperitoneum. Immunohistochemical staining also verified that hydromorphone could increase the expression of HO-1 in lung tissues in mice subjected to CO2 pneumoperitoneum. Notably, in mice treated with HO-1-siRNA, the protective effects of hydromorphone against pneumoperitoneum-induced lung injury were abolished, and hydromorphone did not have additional protective effects on mitochondria. Additionally, in clinical patients who received laparoscopic gynecological surgery, pretreatment with hydromorphone resulted in lower serum levels of club cell secretory protein-16 (CC-16) and intercellular adhesion molecule-1 (ICAM-1), a lower prooxidant-antioxidant balance (PAB), and higher heme oxygenase-1 (HO-1) activity than morphine pretreatment. Collectively, our results suggest that hydromorphone protects against CO2 pneumoperitoneum-induced lung injury via HO-1-regulated mitochondrial dynamics and may be a promising strategy to treat CO2 pneumoperitoneum-induced lung injury.
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Liang LC, Liu DL, Liu SJ, Hu L, He YR, Wan X, Liu L, Zhu ZQ. Risk Factors for Severe Complications After Laparoscopic Surgery for T3 or T4 Rectal Cancer for Chinese Patients: Experience from a Single Center. Med Sci Monit 2020; 26:e920604. [PMID: 32764534 PMCID: PMC7433389 DOI: 10.12659/msm.920604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Patients with rectal cancer are usually at advanced stage with or beyond serosa invasion in China. Severe complications after laparoscopic rectal surgery leads to prolonged hospitalization and high medical cost. This study aimed to explore risk factors for severe complications after laparoscopic surgery of T3 or T4 rectal cancer. Material/Methods A total of 287 patients diagnosed with T3 or T4 rectal cancer were enrolled from the Department of Gastrointestinal Surgery of Anhui Provincial Hospital from February 2012 to February 2017. Univariate analysis and multivariable logistic regression model were used to analyze the risk factors for severe complications (Clavien-Dindo grade ≥III) after laparoscopic surgery. Results Eighteen patients (6.25%) had severe complications; 15 patients were categorized as Clavien-Dindo grade III, and 3 patients were categorized as Clavien-Dindo grade IV. Univariate analysis showed that male gender, high preoperative white blood cells (WBC), diabetes mellitus, pulmonary dysfunction, and tumor distance from anus were associated with increased risk of severe complications after laparoscopic surgery for rectal cancer. Multivariate analysis showed that preoperative WBC ≥6.9×109/L (OR=5.54 (1.58–19.45), P=0.008), diabetes mellitus (OR=13.07 (3.31–51.67), P=0.000) and pulmonary dysfunction (OR=7.75 (1.69–35.63), P=0.008) were independent risk factors for postoperative severe complications. Conclusions Preoperative high white blood cells, diabetes mellitus and pulmonary dysfunction were independent risk factors for severe complications after laparoscopic surgery for T3 or T4 rectal cancer.
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Affiliation(s)
- Li Chuan Liang
- Department of General Surgery, Anhui Provincial Hospital Affiliated to the Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Dong Liang Liu
- Department of General Surgery, Anhui Provincial Hospital Affiliated to the Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Shao Jun Liu
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Hefei, Anhui, China (mainland)
| | - Lei Hu
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Hefei, Anhui, China (mainland)
| | - Yi Ren He
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Hefei, Anhui, China (mainland)
| | - Xiao Wan
- Department of General Surgery, The First Hospital Affiliated to the University of Science and Technology of China, Hefei, Anhui, China (mainland)
| | - Liu Liu
- Department of General Surgery, Anhui Provincial Hospital Affiliated to the Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Zhi Qiang Zhu
- Department of General Surgery, Anhui Provincial Hospital Affiliated to the Anhui Medical University, Hefei, Anhui, China (mainland)
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One-lung ventilation duration-dependent stress response in thoracotomies and the effect of a low-volume, high-frequency differentiated ventilation strategy on this response. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:336-342. [PMID: 32082881 DOI: 10.5606/tgkdc.dergisi.2019.16826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/23/2018] [Indexed: 11/21/2022]
Abstract
Background This study aims to investigate the effect of ventilation of the non-ventilated lung in patients undergoing one-lung ventilation by a separate low-tidal-volume (1 mL/kg) ventilator at high frequency (30/min) on preventing the effect of one-lung ventilation-associated oxidative damage. Methods The study included 45 patients (24 males, 21 females; mean age 54.6±7.7 years; range, 18 to 65 years) with an American Society of Anesthesiologists risk group of 1 to 2 and scheduled for elective thoracotomy. Patients were randomly divided into three groups as those due for thoracotomy without one-lung ventilation (group 1, n=15), those due for thoracotomy with one-lung ventilation (group 2, n=15), and those due for thoracotomy in whom both lungs were ventilated (group 3, n=15). Blood specimens were collected for ischemia-modified albumin, malondialdehyde, and lactate measurements one minute before one-lung ventilation (t0), 30 minutes after one-lung ventilation (t1), 60 minutes after one-lung ventilation (t2), and at postoperative 24th hour (t3). For group 1, t0 was defined as the time at which the thorax was opened. Results A statistically significant increase in ischemia-modified albumin, malondialdehyde, and lactate levels occurred in group 2 as the duration of one-lung ventilation increased (p<0.01). Plasma ischemia-modified albumin and malondialdehyde levels in group 3 were statistically significantly lower at t1, t2, and t3 compared with group 2 (p<0.01). Plasma lactate levels were significantly lower in group 3 at t1 (p<0.05) and t3 compared with group 2 (p<0.01). Conclusion Separate ventilation of the non-ventilated lung with low tidal volume and high frequency reduces the response to one-lung ventilation-associated oxidative stress in thoracic surgery.
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Liu J, Meng Z, Lv R, Zhang Y, Wang G, Xie J. Effect of intraoperative lung-protective mechanical ventilation on pulmonary oxygenation function and postoperative pulmonary complications after laparoscopic radical gastrectomy. ACTA ACUST UNITED AC 2019; 52:e8523. [PMID: 31166383 PMCID: PMC6556971 DOI: 10.1590/1414-431x20198523] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/27/2019] [Indexed: 11/22/2022]
Abstract
This study aimed to observe the effects of lung-protective ventilation (LPV) on oxygenation index (OI) and postoperative pulmonary complications (PPCs) after laparoscopic radical gastrectomy in middle-aged and elderly patients. A total of 120 patients who were scheduled to undergo laparoscopic radical gastrectomy with an expected time of >3 h were randomly divided into conventional ventilation (CV group) with tidal volume (TV) of 10 mL/kg without positive end-expiratory pressure (PEEP), and lung-protective ventilation (PV group) with 7 mL/kg TV and personal level of PEEP with regular recruitment maneuver every 30 min. Measurements of OI, modified clinical pulmonary infection score (mCPIS), and PPCs were assessed during the perioperative period. Fifty-seven patients in the CV group and 58 in the PV group participated in the data analysis. Patients in the PV group showed better pulmonary dynamic compliance, OI, and peripheral capillary oxygen saturation during and after surgery. The mCPIS was significantly lower in the PV group than in the CV group after surgery. The incidence rate of PPCs was lower in the PV group than in the CV group and the difference was significant in patients whose ventilation time was longer than 6 h in both groups. LPV during laparoscopic radical gastrectomy significantly improved pulmonary oxygenation function and reduced postoperative mCPIS and the incidence of PPCs during the early period after surgery of middle-aged and elderly patients, especially patients whose mechanical ventilation time was longer than 6 h.
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Affiliation(s)
- Jing Liu
- Department of Anesthesia, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Zhipeng Meng
- Department of Anesthesia, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Ran Lv
- Department of Anesthesia, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yaping Zhang
- Department of Anesthesia, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Gaojian Wang
- Department of Anesthesia, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Junran Xie
- Department of Anesthesia, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
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Ozgunay SE, Ustundag Y, Karasu D, Uguz I, Erel O, Korfali G, Kaya M. The Effect of Different Intraabdominal Pressures on Thiol/Disulfide Homeostasis in Children Who Underwent Ambulatory Laparoscopic Surgery: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2018; 28:1142-1147. [DOI: 10.1089/lap.2017.0714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seyda Efsun Ozgunay
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Yasemin Ustundag
- Department of Medical Biochemistry, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Derya Karasu
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Ilken Uguz
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Ozcan Erel
- Department of Medical Biochemistry, University of Health Sciences, Dışkapı Yildirim Beyazit, Research and Education Hospital, Ankara, Turkey
| | - Gulsen Korfali
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Mete Kaya
- Department of Pediatric Surgery, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Guideline Implementation: Minimally Invasive Surgery, Part 1. AORN J 2017; 106:50-59. [PMID: 28662785 DOI: 10.1016/j.aorn.2017.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 11/24/2022]
Abstract
Since its inception in the early 1990s, technological developments have made minimally invasive surgery the preferred approach for many operative procedures. However, perioperative personnel have had to develop new skills and techniques to manage this technology. The advent of robotic-assisted procedures in the early 2000s added another level of complexity to the perioperative arena. The updated AORN "Guideline for minimally invasive surgery" provides guidance for creating a safe environment for patients undergoing a wide range of procedures in which complex, advanced equipment and techniques are used. This article focuses on key points of the guideline that address OR configuration for minimally invasive surgery, safe practices for robotic-assisted procedures, and reducing risks associated with gas insufflation media. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
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Ece I, Ozturk B, Yilmaz H, Yormaz S, Şahin M. The effect of single incision laparoscopic cholecystectomy on systemic oxidative stress: a prospective clinical trial. Ann Surg Treat Res 2017; 92:179-183. [PMID: 28382289 PMCID: PMC5378557 DOI: 10.4174/astr.2017.92.4.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Single incision laparoscopic cholecystectomy (SILC) has become a more frequently performed method for benign gallbladder diseases all over the world. The effects of SILC technique on oxidative stress have not been well documented. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy techniques on systemic oxidative stress by using ischemia modified albumin (IMA). Methods In total, 70 patients who had been diagnosed with benign gallbladder pathology were enrolled for this prospective study. Twenty-one patients underwent SILC and 49 patients underwent laparoscopic cholecystectomy (LC). All operations were performed under a standard anesthesia protocol. Serum IMA levels were analysed before operation, 45 minutes and 24 hours after operation. Results Demographics and preoperative characteristics of the patients were similiar in each group. The mean duration of operation was 37.5 ± 12.5 and 44.6 ± 14.3 minutes in LC and SILC group, respectively. In both groups, there was no statistically significant difference in hospital stay, operative time, or conversion to open surgery. Operative technique did not effect the 45th minute and 24th hour IMA levels. However, prolonged operative time (>30 minutes) caused an early increase in the level of IMA. Twenty-fourth hour IMA levels were not different. Conclusion SILC is an effective and safe surgical prosedure for benign gallbladder diseases. Independent of the surgical technique for cholecystectomy, the prolonged operative time could increase the tissue ischemia.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Bahadir Ozturk
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mustafa Şahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
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Polat M, Ozcan O, Sahan L, Üstündag-Budak Y, Alisik M, Yilmaz N, Erel Ö. Changes in Thiol-Disulfide Homeostasis of the Body to Surgical Trauma in Laparoscopic Cholecystectomy Patients. J Laparoendosc Adv Surg Tech A 2016; 26:992-996. [DOI: 10.1089/lap.2016.0381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Murat Polat
- Department of General Surgery, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Onder Ozcan
- Department of General Surgery, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Leyla Sahan
- Department of Anesthesiology, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Yasemin Üstündag-Budak
- Department of Clinical Chemistry, Bursa Yuksek Ihtisas Research and Education Hospital, Bursa, Turkey
| | - Murat Alisik
- Department of Medical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Nigar Yilmaz
- Department of Clinical Chemistry, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Özcan Erel
- Department of Medical Biochemistry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Koninckx PR, Gomel V, Ussia A, Adamyan L. Role of the peritoneal cavity in the prevention of postoperative adhesions, pain, and fatigue. Fertil Steril 2016; 106:998-1010. [PMID: 27523299 DOI: 10.1016/j.fertnstert.2016.08.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/30/2016] [Accepted: 08/02/2016] [Indexed: 02/08/2023]
Abstract
A surgical trauma results within minutes in exudation, platelets, and fibrin deposition. Within hours, the denuded area is covered by tissue repair cells/macrophages, starting a cascade of events. Epithelial repair starts on day 1 and is terminated by day 3. If repair is delayed by decreased fibrinolysis, local inflammation, or factors in peritoneal fluid, fibroblast growth starting on day 3 and angiogenesis starting on day 5 results in adhesion formation. For adhesion formation, quantitatively more important are factors released into the peritoneal fluid after retraction of the fragile mesothelial cells and acute inflammation of the entire peritoneal cavity. This is caused by mechanical trauma, hypoxia (e.g., CO2 pneumoperitoneum), reactive oxygen species (ROS; e.g., open surgery), desiccation, or presence of blood, and this is more severe at higher temperatures. The inflammation at trauma sites is delayed by necrotic tissue, resorbable sutures, vascularization damage, and oxidative stress. Prevention of adhesion formation therefore consists of the prevention of acute inflammation in the peritoneal cavity by means of gentle tissue handling, the addition of more than 5% N2O to the CO2 pneumoperitoneum, cooling the abdomen to 30°C, prevention of desiccation, a short duration of surgery, and, at the end of surgery, meticulous hemostasis, thorough lavage, application of a barrier to injury sites, and administration of dexamethasone. With this combined therapy, nearly adhesion-free surgery can be performed today. Conditioning alone results in some 85% adhesion prevention, barriers alone in 40%-50%.
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Affiliation(s)
- Philippe R Koninckx
- Department of Obstetrics and Gynecology, Catholic University Leuven, University Hospital, Gasthuisberg, Leuven, Belgium; Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica, Rome, Italy.
| | - Victor Gomel
- Department of Obstetrics and Gynecology, University of British Columbia, Women's Hospital, Vancouver, British Columbia, Canada
| | - Anastasia Ussia
- Gruppo Italo Belga, Villa del Rosario and Gemelli Hospitals Università Cattolica, Rome, Italy
| | - Leila Adamyan
- Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia; Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, Moscow, Russia, Russian Federation
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Oncel M, Kiyici A, Oncel M, Sunam GS, Sahin E, Adam B. Increased ischemia-modified albumin and malondialdehyde levels in videothoracoscopic surgery. Ann Thorac Med 2016; 11:66-70. [PMID: 26933460 PMCID: PMC4748618 DOI: 10.4103/1817-1737.172298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Videothoracoscopic surgery leads to general organ hypoperfusion by reducing mean arterial pressure, systemic vascular resistance, and end-diastolic volume index. Oxidative stress occurs as a result of hypoperfusion. Evaluation of the short-term effects of videothoracoscopic sympathectomy on serum ischemia-modified albumin (IMA), malondialdehyde (MDA), and nitric oxide (NO) levels in patients with primary hyperhidrosis was aimed. METHODS: Twenty-six patients who underwent videothoracoscopic surgery were contributed in this study. Venous blood samples were obtained from these patients 1 h before and after the surgery. IMA, MDA, and NO levels were measured in serum samples by colorimetric methods. Albumin concentrations were also measured for each sample, and albumin-adjusted IMA levels were calculated. RESULTS: Postoperative IMA, albumin-adjusted IMA, and MDA values were significantly higher compared to the preoperative values (P = 0.003, 0.027, 0.018, respectively). However, postoperative NO levels were lower than the preoperative values (P = 0.002). There was no significant difference between pre- and postoperative albumin concentrations, and there was no significant correlation between the parameters tested. CONCLUSIONS: We can conclude that elevation in MDA and IMA levels after videothoracoscopic surgery was caused by increased oxidative stress due to minimal ischemia-reperfusion injury after the infusion of CO2 during the surgical process. Videothoracoscopic sympathectomy operation causes a decrease in NO production, and this should be taken in consideration when evaluating nitrosative stress in videothoracoscopic surgery.
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Affiliation(s)
- Mufide Oncel
- Department of Biochemistry, Medical Faculty, Mevlana University, Konya, Turkey
| | - Aysel Kiyici
- Department of Biochemistry, Medical Faculty, Mevlana University, Konya, Turkey
| | - Murat Oncel
- Department of Thoracic Surgery, Medical Faculty, Selcuk University, Selcuklu, Konya, Turkey
| | - Guven Sadi Sunam
- Department of Thoracic Surgery, Medical Faculty, Selcuk University, Selcuklu, Konya, Turkey
| | - Emel Sahin
- Department of Biochemistry, Medical Faculty, Mevlana University, Konya, Turkey
| | - Bahattin Adam
- Department of Biochemistry, Medical Faculty, Mevlana University, Konya, Turkey
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Erduran E, Bahadir A, Albayrak D, Aliyazicioglu Y, Buyukavci M, Turan I. Positive correlation between insulin resistance and iron overload-induced oxidative stress in patients with fanconi anemia (FA)- and non-FA-related bone marrow failure: The results of a multicenter study. Pediatr Hematol Oncol 2016; 33:13-20. [PMID: 26918367 DOI: 10.3109/08880018.2015.1106626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study investigated the relationship between DNA, protein, and lipid oxidations and insulin resistance in patients with Fanconi anemia (FA)- and non-FA-related bone marrow failure. Sixteen patients with FA, 7 non-FA-related aplastic anemia, and 10 controls were included in the study. Fasting blood glucose, simultaneous insulin, hepcidin, ferritin, 8-hydroxy deoxyguanosine (8-OHdG), protein carbonyls, malondialdehyde (MDA), and homeostatic model assessment-insulin resistance (HOMA-IR) were investigated in the patients and controls. Diepoxybutane test-positive (DEB+) patients were diagnosed with FA, whereas DEB-patients were diagnosed as non-FA. 8-OHdG levels in both FA and non-FA patients were significantly higher than those in the controls (P = .001 and P = .005, respectively). Serum ferritin levels were also higher in FA and non-FA patients than in the controls (P = .0001 and P = .005, respectively). Insulin resistance (IR) was significantly higher in FA patients than in non-FA patients and controls (P = .005 and P = .015, respectively). Significant differences were observed between 8-OHdG, ferritin, and MDA levels in patients with or without IR (P = .009, P = .001, and P = .013, respectively). Moderate and strong relations of 44% and 85% were determined between IR and ferritin levels in patients with FA or non-FA (P = .08 and P = .014, respectively). FA and non-FA patients exhibited a tendency to IR. IR was related to ferritin levels, and ferritin levels were also correlated with oxidative stress. These findings suggest that the increased rate of IR in patients with FA and non-FA may derive from increased oxidative stress, which may in turn be due to elevated serum ferritin levels.
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Affiliation(s)
- Erol Erduran
- a Department of Pediatric Hematology and Oncology, Karadeniz Technical University , Trabzon , Turkey
| | - Aysenur Bahadir
- a Department of Pediatric Hematology and Oncology, Karadeniz Technical University , Trabzon , Turkey
| | - Davut Albayrak
- b Department of Pediatric Hematology, Ondokuz Mayis University , Samsun , Turkey
| | - Yuksel Aliyazicioglu
- c Department of Medical Biochemistry, Karadeniz Technical University , Trabzon , Turkey
| | - Mustafa Buyukavci
- d Department of Pediatric Hematology and Oncology, Ataturk University , Erzurum , Turkey
| | - Ibrahim Turan
- e Department of Genetic and Bioengineering, Gumushane University , Gumushane , Turkey
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Impact of a lung-protective ventilatory strategy on systemic and pulmonary inflammatory responses during laparoscopic surgery: is it really helpful? Inflammation 2015; 38:361-7. [PMID: 25280837 DOI: 10.1007/s10753-014-0039-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Laparoscopic surgery is performed by carbon dioxide (CO2) insufflation, but this may induce stress responses. The aim of this study is to compare the level of inflammatory mediators in patients receiving low tidal volume (VT) versus traditional VT during gynecological laparoscopic surgery. Forty American Society of Anesthesiologists (ASA) physical status 1 and 2 subjects older than 18 years old undergoing laparoscopic gynecological surgery were included. Systemic inflammatory response was assessed with serum IL-6, TNF-alpha, IL-8, and IL-1β in patients receiving intraoperative low VT and traditional VT during laparoscopic surgery [within the first 5 min after endotracheal intubation (T1), 60 min after the initiation of mechanical ventilation (T2), and in the postanesthesia care unit 30 min after tracheal extubation (T3)]. Additionally, inflammatory response was assessed with bronchoalveolar lavage (BAL) at T1 and T3 periods. An increase in the serum levels of IL-6, TNF-alpha, IL-8, and IL-1β was observed in both groups during the time periods of T1, T2, and T3. No significant differences were found in the serum and BAL levels of inflammatory mediators during time periods between groups. The results of the present study suggested that the lung-protective ventilation and traditional strategies are not different in terms of lung injury and inflammatory response during conventional laparoscopic gynecological surgery.
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Lee JY, Choi SH. Evaluation of total oxidant and antioxidant status in dogs under different CO2 pneumoperitoneum conditions. Acta Vet Scand 2015; 57:23. [PMID: 25952751 PMCID: PMC4431533 DOI: 10.1186/s13028-015-0113-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 04/21/2015] [Indexed: 11/19/2022] Open
Abstract
Background The induction of the pneumoperitoneum increases intraabdominal pressure (IAP), causing splanchnic ischemia, whereas its deflation normalizes IAP and splanchnic blood flow. We investigated the oxidant-antioxidant status of dogs who underwent low pressure (7 mm Hg), standard pressure (12 mm Hg), and high pressure (15 mm Hg) pneumoperitoneum. Results Twenty-four beagle dogs (12 males and 12 females), 4–6 years old, weighing 8–11 kg were used. The animals were assigned to one of four groups (n = 6 dogs). Group 1 served as a control; these animals received only anaesthesia for 90 min. In groups 2, 3 and 4, intra-abdominal pressure was increased to 7, 12 and 15 mmHg, respectively, and maintained for 60 min. Total oxidant status (TOS) and total antioxidant status (TAS) were determined in venous blood samples. The percentage ratio of TOS to TAS provided an oxidative stress index (OSI). No significant difference in TOS levels was found among the groups. A significant decrease in TAS levels and an increase in OSI levels were observed at 90 min and 24 h of pneumoperitoneum deflation within group 4. No differences were found among the groups. Conclusions A high pressure pneumoperitoneum induced significant changes in TAS and OSI. In addition, TOS and TAS levels are useful markers for evaluating changes in the oxidative status caused by a pneumoperitoneum during laparoscopy. Furthermore, a low-pressure pneumoperitoneum could attenuate oxidative stress induced by CO2 insufflation in dogs.
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Davarcı I, Karcıoğlu M, Tuzcu K, İnanoğlu K, Yetim TD, Motor S, Ulutaş KT, Yüksel R. Evidence for negative effects of elevated intra-abdominal pressure on pulmonary mechanics and oxidative stress. ScientificWorldJournal 2015; 2015:612642. [PMID: 25685845 PMCID: PMC4320804 DOI: 10.1155/2015/612642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/29/2014] [Indexed: 11/18/2022] Open
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. MATERIALS AND 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.
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Affiliation(s)
- I Davarcı
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - M Karcıoğlu
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K Tuzcu
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K İnanoğlu
- Department of Anesthesiology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - T D Yetim
- Department of Thoracic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - S Motor
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - K T Ulutaş
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - R Yüksel
- Department of Biochemistry, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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Selected oxidative stress markers in gynecological laparoscopy. Wideochir Inne Tech Maloinwazyjne 2014; 10:92-100. [PMID: 25960799 PMCID: PMC4414094 DOI: 10.5114/wiitm.2014.47449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 10/18/2014] [Accepted: 10/26/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The surgical stress response after laparoscopy is smaller when compared with open surgery, and it is expected that after minimally invasive surgery the possible development of oxidative stress will be less severe. AIM To evaluate markers of pro-oxidant activity - levels of lipid peroxides and malondialdehyde - and activity of the antioxidant enzymes superoxide dismutase and glutathione peroxidase in the perioperative period in patients undergoing gynecological laparoscopy and to determine whether the duration of laparoscopy can affect these changes. MATERIAL AND METHODS The study included 64 patients, divided into two groups: group 1 with duration of laparoscopy up to 20 min, and group 2 with duration of the operation over 40 min. Blood samples were collected before anesthesia, 5 min after release of pneumoperitoneum, and 10 h after surgery. RESULTS A statistically significant increase in the levels of lipid peroxides and malondialdehyde in samples collected after surgery was found in comparison with values obtained before surgery. Also statistically significant differences existed between groups of patients with different duration of surgery. Superoxide dismutase and glutathione peroxidase activity values were significantly decreased. They were also significantly different between the two groups with different duration of surgery. CONCLUSIONS In our study, levels of the markers of pro-oxidant activity increased and levels of the markers of antioxidant enzymes decreased, suggesting development of oxidative stress. The duration of laparoscopic procedures affects the severity of the presented changes.
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Zhang W, Wu Q, Li L, Cui T, Sun L, Wang N, Liu L, Li X, Gong C. Prevention of desiccation induced postsurgical adhesion by thermosensitive micelles. Colloids Surf B Biointerfaces 2014; 122:309-315. [DOI: 10.1016/j.colsurfb.2014.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/05/2014] [Accepted: 06/09/2014] [Indexed: 12/08/2022]
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Montelukast prevents ischaemia/reperfusion-induced ovarian damage in rats. Eur J Obstet Gynecol Reprod Biol 2013; 173:71-6. [PMID: 24360058 DOI: 10.1016/j.ejogrb.2013.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 08/04/2013] [Accepted: 11/25/2013] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the efficacy of montelukast for prevention of ischaemia/reperfusion (I/R) injury in rat ovary. STUDY DESIGN Twenty-four female adult rats were included in the study. I/R injury was induced by CO2 pneumoperitoneum in a laparoscopic rat model. The rats were divided at random into three groups: the sham group was subjected to catheter insertion but was not subjected to pneumoperitoneum; the saline group was subjected to 60 min of pneumoperitoneum and 30 min of reperfusion, with 1 mg/kg physiological saline administered 10 min before pneumoperitoneum; and the montelukast group was subjected to 60 min of pneumoperitoneum and 30 min of reperfusion, with 20mg/kg montelukast administered 10 min before pneumoperitoneum. Damage to ovarian tissue was scored by histopathological evaluation. Caspase-3 expression was determined immunohistochemically. Ovarian tissue levels of malondialdehyde and glutathione, and plasma total antioxidant capacity were measured biochemically. RESULTS In comparison with the sham group, ovarian sections in the montelukast group had higher scores for follicular degeneration and oedema (p<0.001). Montelukast treatment prevented tissue damage in ovaries, and this result was significant. Caspase-3 expression was only observed in ovarian surface epithelium in the saline and montelukast groups. However, the mean caspase-3 expression score was higher in the saline group than the montelukast group (p<0.001). Tissue levels of malondialdehyde were higher in the montelukast group than the sham group, but plasma total antioxidant capacity and tissue levels of glutathione were significantly lower. Pretreatment with montelukast reduced lipid peroxidation (p<0.005) and improved antioxidant status in rats (p<0.001). CONCLUSION Montelukast is effective for the prevention of I/R-induced damage in rat ovary.
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Ömür D, Hacıvelioğlu SÖ, Oğuzalp H, Uyan B, Kiraz HA, Duman C, Tütüncüler FK, Hancı V. The effect of anaesthesia technique on maternal and cord blood ischaemia-modified albumin levels during caesarean section: A randomized controlled study. J Int Med Res 2013; 41:1111-9. [DOI: 10.1177/0300060512474133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Ischaemia-modified albumin (IMA) is an early marker for various ischaemic events, including cardiac ischaemia. This study determined variations in IMA levels during caesarean section, performed under general anaesthesia or with combined spinal epidural anaesthesia. Methods Full-term, healthy pregnant women were allocated to undergo caesarean section, using either general anaesthesia or combined spinal epidural anaesthesia. IMA and albumin levels were measured in maternal serum samples taken immediately prior to caesarean section and 30 min into the procedure, as well as from serum taken from cord blood after double clamping. Results At total of 51 healthy pregnant women underwent either general anaesthesia ( n = 28) or combined spinal epidural anaesthesia ( n = 23). Within-group analysis of the general anaesthesia group showed that both IMA levels and IMA/albumin ratios were significantly higher at 30 min of surgery compared with the immediate preoperative period. Conclusions Lower IMA levels in the combined spinal epidural anaesthesia group may have been due to improved balancing of oxidative stress during caesarean section. Further research on IMA levels during caesarean section should take into account the method of anaesthesia used.
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Affiliation(s)
- Dilek Ömür
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Servet Özden Hacıvelioğlu
- Department of Gynaecology and Obstetrics, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hüseyin Oğuzalp
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Berna Uyan
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Hasan Ali Kiraz
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Can Duman
- Department of Biochemistry, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | | | - Volkan Hancı
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Cekic B, Besir A, Yulug E, Geze S, Alkanat M. Protective effects of dexmedetomidine in pneumoperitoneum-related ischaemia-reperfusion injury in rat ovarian tissue. Eur J Obstet Gynecol Reprod Biol 2013; 169:343-6. [PMID: 23601417 DOI: 10.1016/j.ejogrb.2013.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 11/02/2012] [Accepted: 03/12/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To determine the effects of dexmedetomidine on pneuomoperitoneum-related ischaemia-reperfusion (I/R) injury in rat ovarian tissue. STUDY DESIGN Animals were randomized into three groups: Group S (n=8), no pneumoperitoneum; Group C (n=8), pneumoperitoneum; and Group D (n=8), 100μg intraperitoneal dexmedetomidine 30min before pneumoperitoneum. Ovarian tissue was collected from all rats 30min after desufflation, and fresh frozen for histological and biochemical evaluation. RESULTS Body weight was similar in all three groups (202.62±28.86, 211.00±14.45 and 212.87±15.71g in Groups S, D and C, respectively). The mean malondialdehyde level was higher in Group C than the other groups (p<0.03). When the histological samples of ovarian tissue were compared, vascular congestion, haemorrhage, follicular cell degeneration and infiltrative cell infiltration scores were higher in Group C compared with the other groups (p<0.05). Significantly lower scores for the histological parameters were found in Group D compared with Group C (p<0.05). Similar scores for follicular cell degeneration and inflammatory cell infiltration were found in Group D and Group S (p>0.05). Although vascular congestion and haemorrhage scores were significantly lower compared with Group C, higher scores were found for Group D compared with Group S (p<0.05). CONCLUSION Pneumoperitoneum caused oxidative injury in rat ovarian tissue. Dexmedetomidine reduced oxidative stress and histological injury related to I/R.
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Affiliation(s)
- B Cekic
- Department of Anaesthesiology and Critical Care, Karadeniz Technical University, Faculty of Medicine, Turkey.
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