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Uscategui RA, Barros FF, Almeida VT, Kawanami AE, Feliciano MA, Vicente WR. Evaluation of chemical restraint, isoflurane anesthesia and methadone or tramadol as preventive analgesia in spotted pacas (Cuniculus paca) subjected to laparoscopy. Vet Anaesth Analg 2020; 48:82-91. [PMID: 33229231 DOI: 10.1016/j.vaa.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and cardiopulmonary effects of ketamine-midazolam for chemical restraint, isoflurane anesthesia and tramadol or methadone as preventive analgesia in spotted pacas subjected to laparoscopy. STUDY DESIGN Prospective placebo-controlled blinded trial. ANIMALS A total of eight captive female Cuniculus paca weighing 9.3 ± 0.9 kg. METHODS Animals were anesthetized on three occasions with 15 day intervals. Manually restrained animals were administered midazolam (0.5 mg kg-1) and ketamine (25 mg kg-1) intramuscularly. Anesthesia was induced and maintained with isoflurane 30 minutes later. Tramadol (5 mg kg-1), methadone (0.5 mg kg-1) or saline (0.05 mL kg-1) were administered intramuscularly 15 minutes prior to laparoscopy. Heart rate (HR), respiratory rate, mean arterial pressure (MAP), peripheral oxygen saturation (SpO2), end-tidal CO2 partial pressure (Pe'CO2), end-tidal concentration of isoflurane (Fe'Iso), pH, PaO2, PaCO2, bicarbonate (HCO3-), anion gap (AG) and base excess (BE) were monitored after chemical restraint, anesthesia induction and at different laparoscopy stages. Postoperative pain was assessed by visual analog scale (VAS) for 24 hours. Variables were compared using anova or Friedman test (p < 0.05). RESULTS Chemical restraint was effective in 92% of animals. Isoflurane anesthesia was effective; however, HR, MAP, pH and AG decreased, whereas Pe'CO2, PaO2, PaCO2, HCO3- and BE increased. MAP was stable with tramadol and methadone treatments; HR, Fe'Iso and postoperative VAS decreased. VAS was lower for a longer time with methadone treatment; SpO2 and AG decreased, whereas Pe'CO2, PaCO2 and HCO3- increased. CONCLUSIONS AND CLINICAL RELEVANCE Ketamine-midazolam provided satisfactory restraint. Isoflurane anesthesia for laparoscopy was effective but resulted in hypotension and respiratory acidosis. Tramadol and methadone reduced isoflurane requirements, provided postoperative analgesia and caused hypercapnia, with methadone causing severe respiratory depression. Thus, the anesthetic protocol is adequate for laparoscopy in Cuniculus paca; however, methadone should be avoided.
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Affiliation(s)
- Ricardo Ar Uscategui
- Institute of Agrarian Sciences, Federal University of Jequithonha and Mucury Valleys (UFVJM), Unaí, MG, Brazil; Department of Veterinary Pathobiology and Theriogenology, São Paulo State University (Unesp), "Julio de Mesquita Filho", Jaboticabal, SP, Brazil.
| | - Felipe Fpc Barros
- Department of Medicine and Veterinary Surgery, Federal Rural University of Rio de Janeiro (UFRRJ), Seropédica, RJ, Brazil
| | - Vívian T Almeida
- Department of Veterinary Pathobiology and Theriogenology, São Paulo State University (Unesp), "Julio de Mesquita Filho", Jaboticabal, SP, Brazil
| | - Aline E Kawanami
- Department of Veterinary Pathobiology and Theriogenology, São Paulo State University (Unesp), "Julio de Mesquita Filho", Jaboticabal, SP, Brazil
| | - Marcus Ar Feliciano
- Department of Large Animal Clinic, Federal University of Santa Maria (UFSM), Santa Maria, RS, Brazil
| | - Wilter Rr Vicente
- Department of Veterinary Pathobiology and Theriogenology, São Paulo State University (Unesp), "Julio de Mesquita Filho", Jaboticabal, SP, Brazil
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Uscategui R, Santos V, Almeida V, Barros F, Kawanami A, Cruz N, Feliciano M, Vicente W. Hematological and biochemical parameters in Spotted Paca (Cuniculus paca) undergoing pharmacological restraint and general anesthesia. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The aim of this study was to assess the effects of chemical restraint, general anesthesia and opioid treatment on hematological components in Cuniculus paca. Eight healthy, adult, captivity female animals , underwent three laparoscopic procedures with a 15-day interval were evaluated. After physical restraint, an association of ketamine (25mg/kg) and midazolam (0.5mg/kg) was administered intramuscularly for chemical restraint. Posteriorly, anesthesia was induced and maintained with isoflurane; and randomly administered methadone (0.5mg/kg), tramadol (5mg/kg) or saline-placebo (0,1mL/kg) intramuscularly. After pharmacological restraint and in the final laparoscopy stage, venous blood samples were obtained for complete blood count, total plasma protein (TP), creatinine, alanine aminotransferase (ALT), sodium, potassium, chloride and ionized calcium analysis. During general anesthesia, hemoglobin, TP concentration and lymphocytes decreased (P=0.029; <0.001; 0.022 respectively), whereas the potassium levels increased (P=0.034). In conclusion, chemical restraint with ketamine/midazolam association causes a slight decrease in blood cellular components. Isoflurane anesthesia for laparoscopic procedure lead to decrease in hemoglobin, lymphocytes and protein concentrations, while potassium increased, without any influence from the tramadol or methadone treatment. However, these alterations were transient, and its hematologic values can collaborate in carrying out epidemiological, pathophysiological or case studies in the Cuniculus paca.
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Affiliation(s)
- R.A.R. Uscategui
- Universidade Estadual Paulista, Brazil; Universidade Federal dos Vales do Jequitinhonha e Mucuri, Brazil
| | | | | | - F.F.P.C. Barros
- Universidade Estadual Paulista, Brazil; Universidade Federal Rural do Rio de Janeiro, Brazil
| | | | | | - M.A.R. Feliciano
- Universidade Estadual Paulista, Brazil; Universidade Federal de Santa Maria, Brazil
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Almeida V, Uscategui R, Restan W, Feliciano M, Ortiz E, Kawanami A, Barros F, Santos V, Vicente W. Cardiovascular assessment in Female Spotted Paca ( Cuniculus paca ). ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-10146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Aiming to provide cardiovascular morphophysiology information on the Cuniculus paca, an important neotropical rodent, eight healthy adult females of this species were evaluated three times by echocardiography under general anesthesia with isoflurane every 15 days. The exams were performed by a single experienced evaluator with the animals positioned in right and left decubitus. Posteriorly, two expert evaluators measured the cardiac chambers, walls and flow patterns, by B-mode, M-mode, and Doppler ultrasonography. The resulting values were compared among evaluators and periods by the Bland-Altman agreement test and several descriptive statistics were presented for each parameter. Echocardiographic images were obtained between the second and fifth left and right intercostal spaces, enabling the measurement of heart chambers and walls, mitral, tricuspid, aortic and pulmonary valves blood flows, and the ejection and shortening fractions calculation. None of the studied variables showed inter-observers or inter-periods variations. This study provided some normal echocardiographic variables, applicable to epidemiological, pathophysiological or case studies in the Cuniculus paca and phylogenetically close species.
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Affiliation(s)
| | | | | | - M.A.R. Feliciano
- Universidade Estadual Paulista, Brazil; Universidade Federal do Recôncavo da Bahia, Brazil
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Miranda A, Pêgo JM, Correia-Pinto J. Animal facility videoendoscopic intubation station: tips and tricks from mice to rabbits. Lab Anim 2016; 51:204-207. [PMID: 27230409 DOI: 10.1177/0023677216652342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Endotracheal intubation of laboratory animals is a common procedure shared by several research fields for different purposes, such as mechanical ventilation of anaesthetized animals, instillation of cytotoxic nanoparticles, infectious agents or tumour cells for induction of disease models, and even for diagnostic and therapeutic purposes. These different research purposes, achieved in different animal models, require technical expertise and equipment that suits every research need from animal facilities. In this short report we propose a videoendoscopic intubation station that could be shared among the most common laboratory animals, namely the mouse, rat, guinea pig and rabbit, from neonates to adult animals. This report aims to contribute to the reduction of animals excluded from experiments due to false paths during direct and blind intubations and to the refinement of procedures by replacing surgical approaches such as tracheotomy.
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Affiliation(s)
- Alice Miranda
- 1 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,2 ICVS/3Bs - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - José M Pêgo
- 1 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,2 ICVS/3Bs - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Jorge Correia-Pinto
- 1 Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,2 ICVS/3Bs - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,3 Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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Konno K, Shiotani Y, Itano N, Ogawa T, Hatakeyama M, Shioya K, Kasai N. Visible, safe and certain endotracheal intubation using endoscope system and inhalation anesthesia for rats. J Vet Med Sci 2014; 76:1375-81. [PMID: 25030602 PMCID: PMC4221171 DOI: 10.1292/jvms.14-0146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Anesthesia strongly influences
laboratory animals, and it can also greatly affect the experimental data. Rats rank only
second to mice in the number used in research fields, such as organ transplantation,
regenerative medicine and imaging. Therefore, appropriate and effective anesthesia,
including the protocol of the endotracheal intubation and inhalation anesthesia, is
crucial. Hence, we evaluated these methods in this study. Twelve Wistar rats were
intraperitoneally injected with M/M/B: 0.3/4/5, comprising of medetomidine, midazolam and
butorphanol at a dose of 0.3 mg/kg + 4.0 mg/kg + 5.0 mg/kg body weight/rat, respectively.
An endotracheal tube was then intubated into the trachea. After intubation, the rats were
connected to the inhalation anesthesia circuit using isoflurane, and vital signs were
measured until 30 min after connection. All intubations were successfully finished within
1 min, and the values of the vital signs were normal and stable. In addition,
histopathological observation of the trachea and lungs showed no trauma. These results
suggest that this visible endotracheal intubation method is simple, reliable, safe and
favorable with regard to the rats’ welfare.
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Affiliation(s)
- Kenjiro Konno
- Department of Animal Medical Sciences, Faculty of Life Sciences, Kyoto Sangyo University, Kamigamo, Kita-ku, Kyoto 603-8555, Japan
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Konno K, Itano N, Ogawa T, Hatakeyama M, Shioya K, Kasai N. New visible endotracheal intubation method using the endoscope system for mice inhalational anesthesia. J Vet Med Sci 2014; 76:863-8. [PMID: 24584082 PMCID: PMC4108770 DOI: 10.1292/jvms.13-0647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Appropriate and effective anesthesia is critical, because it has a strong
influence on laboratory animals, and its affect greatly impacts the experimental data.
Inhalational anesthesia by endotracheal intubation is currently prevailing in general
anesthesia and is prefered over injection anesthesia, especially for large laboratory
animals, because it is a safe and easy control agent. However, it is not common for small
laboratory animals, because of the high degree of technical skills required. We assessed
the capability of use for mice of the endotracheal intubation by using the endoscope
system “TESALA AE-C1” and inhalational anesthesia using a ventilator. Endotracheal
intubation was successfully performed on all 10 C57BL/6 mice injected with M/M/B: 0.3/4/5
comprised of medetomidine, midazoram and butorphanol, at a dose of 0.3 mg/kg + 4.0 mg/kg +
5.0 mg/kg body weight/mouse, respectively. After the intubated mice were connected with
the inhalational anesthesia circuit and the ventilator, vital signs were measured until 15
min after the connection. The data with M/M/B: 0.3/4/5 showed stable and normal values,
which indicated that this new endotracheal intubation method was simple, reliable and
safe, which mean that this anesthesia is favorable in regard to the animal’s welfare.
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Affiliation(s)
- Kenjiro Konno
- Department of Animal Medical Sciences, Faculty of Life Sciences, Kyoto Sangyo University, Kamigamo, Kita-ku, Kyoto 603-8555, Japan
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A secure and rapid method for orotracheal intubation of laboratory rats utilising handy instruments. Eur J Anaesthesiol 2013; 29:515-9. [PMID: 22935959 DOI: 10.1097/eja.0b013e328357ce5b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Tracheal intubation of anaesthetised rats for laboratory experiments remains an essential yet challenging procedure. OBJECTIVE We aimed to investigate whether tracheal intubation can be safely and securely accomplished in laboratory rats employing only handy instruments and with minimal experience. DESIGN The feasibility and safety of a modified orotracheal intubation method was evaluated in rats undergoing open-chest surgery as part of another research protocol, and compared with an existing technique. SETTING The study was carried out in a tertiary medical centre-affiliated animal laboratory. ANIMALS Eighty-five rats weighing 250 to 350 g anaesthetised with intraperitoneal pentobarbital (60 mg kg(-1)). INTERVENTIONS Orotracheal intubation was performed on 35 animals (group Jou) using a previously reported technique and then on another 50 rats (group New) using the modified method employing a 3-ml syringe-derived intubation wedge, a 0.025-inch guidewire and a 16-gauge 45-mm-long intravenous catheter. MAIN OUTCOME MEASURES The time for completion, the number of attempts and the incidence of difficulties and complications were recorded. The intubated tracheas were subsequently examined macroscopically and microscopically to determine position of the intubation catheter and the integrity of epithelial lining. RESULTS Compared with the previous technique, the new method was completed more rapidly (1 ± 0.2 vs. 5 ± 2.4 min; P < 0.001), more smoothly (difficulties encountered in 8 vs. 74%; P < 0.001), with greater overall success (100 vs. 86%; P=0.022) and with fewer attempts [1 (1 to 1) vs. 2 (2 to 4); P < 0.001) for the new and Jou techniques, respectively, and with a lower incidence of procedure-related complications. Postmortem analysis confirmed there was no microscopic injury to the tracheal epithelial lining with the new technique in contrast to 57% in those using the Jou technique (P < 0.001). CONCLUSION Tracheal intubation for laboratory rats can be securely and safely completed with the modified method employing a short learning curve and easily available devices.
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Abstract
This technique was performed to allow for an additional approach to assist in ventilation. A modified ventilation nose cone was placed over the nose, which allowed the animal to not require endotracheal intubation. This method was effective in ventilating the animals during thoracic and abdominal procedures without requiring endotracheal intubation.
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Tytgat SHAJ, Rijkers GT, van der Zee DC. The influence of the CO₂ pneumoperitoneum on a rat model of intestinal anastomosis healing. Surg Endosc 2011; 26:1642-7. [PMID: 22179471 PMCID: PMC3351619 DOI: 10.1007/s00464-011-2086-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 11/21/2011] [Indexed: 11/26/2022]
Abstract
Background The CO2 pneumoperitoneum, which is used for laparoscopic surgery, causes local and systemic effects in patients. Concern arises about what the pressurized anoxic environment of the CO2 pneumoperitoneum has on intestinal healing. Earlier experimental work showed a negative correlation between intestinal healing and the applied intra-abdominal pressure. To further elucidate this, we developed a rat model, in which enterotomy healing can be compared after open or laparoscopic surgery. Possible mechanisms of injury, such as impaired neoangiogenesis or injury through hypoxia-induced pathways were studied. Methods A new experimental mechanically ventilated rat model was developed. An enterotomy was made and closed via laparotomy (group I) or laparoscopy under CO2 pressures of 5 mmHg (group II) or 10 mmHg (group III). Intestinal healing was tested in vivo after 1 week by bursting-pressure analysis. The effect of the operative procedure on neoangiogenesis was tested by counting factor VIII positive vessels in biopsies of the perianastomotic granulation tissue after 1 week. Intestinal anoxia was tested by quantifying HIF-1α protein levels in intestinal biopsies, taken before the enterotomy closure. Results The bursting pressures were significantly lower after laparoscopic surgery at 10 mmHg CO2 pneumoperitoneum (group III) compared with rats that had undergone open surgery (group I) or laparoscopic surgery at 5 mmHg CO2 pneumoperitoneum (group II). There was no significant quantitative difference between the three groups in the neoangiogenesis nor was there a difference in the amount of HIF-1α measured in the intestinal biopsies. Conclusions We developed a surgical model that is well fitted to study the effects of pneumoperitoneum on intestinal healing. With this model, we found further evidence of CO2 pressure-dependant hampered intestinal healing. These differences could not be explained by difference in neoangiogenesis nor local upregulation of hypoxic factors.
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Affiliation(s)
- Stefaan H A J Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, KE.04.140.5, PO Box 85090, 3508, AB Utrecht, The Netherlands.
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Leite CF, Toro IFC, Antunes E, Mussi RK. Standardization of a method of prolonged thoracic surgery and mechanical ventilation in rats to evaluate local and systemic inflammation. Acta Cir Bras 2011; 26:38-43. [DOI: 10.1590/s0102-86502011000100008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 10/20/2010] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the immediate pulmonary and systemic inflammatory response after a long-term operative period. Methods: Wistar rats in the experimental group were anaesthetized and submitted to tracheostomy, thoracotomy and remained on mechanical ventilation during three hours. Control animals were not submitted to the operative protocol. The following parameters have been evaluated: pulmonary myeloperoxidase activity, pulmonary serum protein extravasation, lung wet/dry weight ratio and measurement of levels of cytokines in serum. Results: Operated animals exhibited significantly lower serum protein extravasation in lungs compared with control animals. The lung wet/dry weight ratio and myeloperoxidase activity did not differ between groups. Serum cytokines IL-1ß, TNF-, and IL-10 levels were not detected in groups, whereas IL-6 was detected only in operated animals. Conclusion: The experimental mechanical ventilation in rats with a prolonged surgical time did not produce significant local and systemic inflammatory changes and permit to evaluate others procedures in thoracic surgery.
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Abstract
Rabbits, guinea pigs, chinchillas and many other small exotic mammals are not intubated routinely, because intubation requires specialized equipment and is difficult to perfect. Using a face mask for these species solely on the basis that they are unable to regurgitate ignores the numerous other benefits of airway control. This article summarizes the many advantages of endotracheal intubation and the various methods of intubation that have been reported. It introduces endoscopic intubation as a method that overcomes many of the difficulties associated with other methods and describes the equipment needed, how to intubate with an endoscope, how to confirm proper endotracheal tube placement, and possible complications. Over-the-endoscope intubation is discussed in detail, as it appears to provide the most versatile and reliable method of intubating exotic companion mammals.
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Affiliation(s)
- Dan H Johnson
- Avian and Exotic Animal Care, 8711 Fidelity Boulevard, Raleigh, NC 27617, USA.
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Moldestad O, Karlsen P, Molden S, Storm JF. Tracheotomy improves experiment success rate in mice during urethane anesthesia and stereotaxic surgery. J Neurosci Methods 2008; 176:57-62. [PMID: 18778735 DOI: 10.1016/j.jneumeth.2008.08.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2008] [Revised: 07/30/2008] [Accepted: 08/01/2008] [Indexed: 11/18/2022]
Abstract
Urethane anesthesia is frequently used for acute experiments on small rodents in physiology and neuroscience. Severe respiratory distress is a common side-effect of urethane anesthesia in many strains of mice. Associated complications interfere with completion of experiments, and as a consequence more animals must be sacrificed. During experiments with stereotaxic brain surgery, we found that intubation by means of tracheotomy is an efficient way to maintain patent airways in these animals. Artificial ventilation of the animals is not required. In this paper we describe a simple, fast and reliable method for intubation of mice in experiments that involve a stereotaxic instrument. The method proved considerably easier to learn and apply than conventional intubation through the oral route. The incidence of breathing problems decreased from 77% in untreated mice to 9% in those that underwent tracheotomy. In addition, the success rate for our acute electrophysiological experiments increased from 24 to 77%. We conclude that tracheotomy reduces the number of sacrificed animals, and saves time and labor.
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Affiliation(s)
- Olve Moldestad
- Centre for Molecular Biology and Neuroscience, Department of Physiology, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Domus Medica, Sognsvannsveien 9, PB1103 Blindern, 0317 Oslo, Norway.
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Hanly EJ, Aurora AA, Shih SP, Fuentes JM, Marohn MR, De Maio A, Talamini MA. Peritoneal acidosis mediates immunoprotection in laparoscopic surgery. Surgery 2007; 142:357-64. [PMID: 17723887 DOI: 10.1016/j.surg.2007.02.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 02/22/2007] [Accepted: 02/25/2007] [Indexed: 01/27/2023]
Abstract
BACKGROUND We have shown previously that abdominal insufflation with CO(2) increases serum levels of IL-10 and TNFalpha and increases survival among animals with lipopolysaccharide (LPS)-induced sepsis, even after a laparotomy. We demonstrated previously that the effect of CO(2) is not from changes in systemic pH, although the peritoneum is locally acidotic during abdominal insufflation with CO(2) even when systemic pH is corrected. We hypothesized that acidification of the peritoneum via means other than CO(2) insufflation would produce alterations in the inflammatory response similar to those associated with CO(2) pneumoperitoneum. METHODS In total, 42 rats were randomized into 7 groups (n = 6): 1) LPS only, 2) anesthesia control, 3) helium pneumoperitoneum, 4) CO(2) pneumoperitoneum, 5) buffered mild acid lavage, 6) buffered strong acid lavage, and 7) buffered strong acid lavage + helium pneumoperitoneum. Animals received anesthesia with vaporized isoflurane (except the LPS-only group) and their respective abdominal treatment (pneumoperitoneum and/or lavage) for 30 min followed immediately by stimulation with systemic LPS (1 mg/kg, IV). Blood was harvested via cardiac puncture 60 min after LPS injection, and serum levels of IL-10 and TNFalpha levels were determined by enzyme-linked immunosorbent assay. RESULTS Mean peritoneal pH decreased (P < .05) after CO(2) pneumoperitoneum, buffered strong acid lavage, and buffered strong acid lavage + helium pneumoperitoneum, and it decreased (P = .1) after helium pneumoperitoneum alone and buffered mild acid lavage. IL-10 levels were increased (P < .01), and TNFalpha levels decreased (P < .001) among animals with acidic peritoneal cavities compared with animals with pH-normal peritoneal cavities. Decreasing peritoneal pH correlated with both increasing IL-10 levels (r = -.465, P < .01) and decreasing TNFalpha levels (r = 0.448, P < .01). Among animals with peritoneal acidosis, there were no differences in levels of IL-10 or TNFalpha regardless of insufflation status (P > .05 for both cytokines). CONCLUSIONS Acidification of the peritoneal cavity whether by abdominal insufflation or by peritoneal acid lavage increases serum IL-10 and decreases serum TNFalpha levels in response to systemic LPS challenge. The degree of peritoneal acidification correlates with the degree of inflammatory response reduction. These results support the hypothesis that pneumoperitoneum-mediated attenuation of the inflammatory response after laparoscopic surgery occurs via a mechanism of peritoneal cell acidification.
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Affiliation(s)
- Eric J Hanly
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bourdel N, Matsuzaki S, Bazin JE, Pouly JL, Mage G, Canis M. Peritoneal tissue-oxygen tension during a carbon dioxide pneumoperitoneum in a mouse laparoscopic model with controlled respiratory support. Hum Reprod 2007; 22:1149-55. [PMID: 17208946 DOI: 10.1093/humrep/del482] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous animal studies suggested that the peritoneal environment during a carbon dioxide (CO(2)) pneumoperitoneum is hypoxic and that this may contribute to the formation of intra-abdominal adhesions or the growth of malignant cells. There is no study, however, that investigates the relationship between anaesthesia, ventilation and the laparoscopic peritoneal environment to the development of hypoxia. The objective of this study is to monitor the peritoneal tissue-oxygen tension (PitO(2)) under various conditions including anaesthesia alone, during a CO(2) pneumoperitoneum at both low and high intraperitoneal pressure (IPP), and laparotomy, in animal models with controlled respiratory support (CRS). METHODS C57BL6 mice were divided into eight groups (n = 5) consisting of anaesthesia alone or with CO(2) pneumoperitoneum at low (2 mmHg) or high (8 mmHg) IPP or undergoing laparotomy. Groups were further subdivided into those with or without CRS with endotracheal intubation and mechanical ventilation. Over the course of the 1 h procedure, PitO(2) was continuously monitored. RESULTS Protocol 1. The PitO(2) levels (104.2 +/- 7.8 mmHg, mean +/- SEM) in non-injured peritoneum during a CO(2) pneumoperitoneum at a low IPP were elevated approximately 2-fold over the levels during laparotomy (49.8 +/- 15.0 mmHg) in ventilated mice. Protocol 2. After insufflation with CO(2), the PitO(2) was immediately elevated and maintained at a higher level. Following laparotomy, it decreased immediately. This elevation was not seen with air insufflation. CONCLUSION In mice, a significant elevation in PitO(2) occurs during a CO(2) pneumoperitoneum at low IPP with CRS.
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Affiliation(s)
- Nicolas Bourdel
- Université d'Auvergne - Clermont I, Centre d'Endoscopie et des Nouvelles Techniques Interventionnelles (CENIT), Faculté de Médecine, Clermont-Ferrand, France
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Fuentes JM, Hanly EJ, Aurora AR, De Maio A, Shih SP, Marohn MR, Talamini MA. Laparoscopic surgery and the parasympathetic nervous system. Surg Endosc 2006; 20:1225-32. [PMID: 16865627 DOI: 10.1007/s00464-005-0280-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 09/07/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Laparoscopic surgery preserves the immune system and has anti-inflammatory properties. CO2 pneumoperitoneum attenuates lipopolysaccharide (LPS)-induced cytokine production and increases survival. We tested the hypothesis that CO2 pneumoperitoneum mediates its immunomodulatory properties via stimulation of the cholinergic pathway. METHODS In the first experiment, rats (n = 68) received atropine 1 mg/kg or saline injection 10 min prior to LPS injection and were randomization into four 30-min treatment subgroups: LPS only control, anesthesia control, CO2 pneumoperitoneum, and helium pneumoperitoneum. In a second experiment, rats (n = 40) received atropine 2 mg/kg or saline 10 min prior to randomization into the same four subgroups described previously. In a third experiment, rats (n = 96) received atropine 2 mg/kg or saline 10 min prior to randomization into eight 30-min treatment subgroups followed by LPS injection: LPS only control; anesthesia control; and CO2 or helium pneumoperitoneum at 4, 8, and 12 mmHg. In a fourth experiment, rats (n = 58) were subjected to bilateral subdiaphragmatic truncal vagotomy or sham operation. Two weeks postoperatively, animals were randomized into four 30-min treatment subgroups followed by LPS injection: LPS only control, anesthesia control, CO2 pneumoperitoneum, and helium pneumoperitoneum. Blood samples were collected from all animals 1.5 h after LPS injection, and cytokine levels were determined by enzyme-linked immunosorbent assay. RESULTS Serum tumor necrosis factor-alpha (TNF-alpha) levels were consistently suppressed among the saline-CO2 pneumoperitoneum groups compared to saline-LPS only control groups (p < 0.05 for all four experiments). All chemically vagotomized animals had significantly reduced TNF-alpha levels compared to their saline-treated counterparts (p < 0.05 for all), except among the CO2 pneumoperitoneum-treated animals. Increasing insufflation pressure with helium eliminated differences (p < 0.05) in TNF-alpha production between saline- and atropine-treated groups but had no effect among CO2 pneumoperitoneum-treated animals. Finally, vagotomy (whether chemical or surgical) independently decreased LPS-stimulated TNF-alpha production in all four experiments. CONCLUSION CO2 pneumoperitoneum modulates the immune system independent of the vagus nerve and the cholinergic pathway.
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Affiliation(s)
- J M Fuentes
- Department of Surgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 665, Baltimore, MD, 21287-4665, USA
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Hanly EJ, Bachman SL, Marohn MR, Boden JH, Herring AE, De Maio A, Talamini MA. Carbon dioxide pneumoperitoneum–mediated attenuation of the inflammatory response is independent of systemic acidosis. Surgery 2005; 137:559-66. [PMID: 15855930 DOI: 10.1016/j.surg.2005.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The purpose of this study was to determine if systemic acidosis induced by peritoneal absorption of carbon dioxide (CO2 ) during laparoscopy plays a role in CO2 pneumoperitoneum-mediated attenuation of the acute phase inflammatory response associated with perioperative sepsis. The influence of hepatic polymorphonuclear (PMN) leukocyte infiltration on this phenomenon was also investigated. METHODS Forty-five rats were randomized into 5 groups: anesthesia control, open cecal ligation and puncture (OCLP), laparoscopic cecal ligation and puncture using helium for insufflation (He LCLP), LCLP using CO2 with continued spontaneous ventilation (LCLP-SV), and LCLP using CO2 with intubation and positive pressure ventilation (LCLP-PPV). RESULTS After 30 minutes, arterial blood gas parameters remained normal in control, OCLP rats, and He LCLP rats, while CO2 LCLP-SV rats developed significant hypercarbic acidosis. This acidosis was corrected in CO2 LCLP-PPV rats ( P < .0001 vs CO2 LCLP-SV for both). Expression of the rat acute phase gene alpha 2 -macroglobulin was greater after OCLP and He LCLP than after either CO2 LCLP-SV or CO2 LCLP-PPV ( P < .0001 vs either CO2 OCLP-SV for both). However, levels of alpha 2 -macroglobulin were not significantly different between the acidotic (LCLP-SV) and normocarbic (LCLP-PPV) CO2 groups. Infiltration of the hepatic parenchyma by PMNs did not differ significantly between groups. CONCLUSIONS CO2 insufflation-induced systemic acidosis is not responsible for the reduction in the acute phase inflammatory response observed in laparoscopic animal models of sepsis. Hepatic PMN infiltration also does not appear to mediate this effect.
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Affiliation(s)
- Eric J Hanly
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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