The effects of enoxaparin on the liver in experimental pneumoperitoneum model

ABSTRACT PURPOSE: To investigate the potential protective effects of enoxaparin against the adverse events of carbon dioxide (CO2) pneumoperitoneum. METHODS: Thirty four rats were divided into three groups: Group 1 (sham) underwent insertion of Veress needle into the abdomen and 90 min of anesthesia with no gas insufflation. The animals in control and enoxaparin groups were subjected to 90 min of 14 mmHg CO2 pneumoperitoneum. Enoxaparin (100 u/kg) was administered subcutaneously to the rats in enoxaparin group one hour before the operation. After 90 min of pneumoperitoneum, the rats were allowed for reperfusion through 60 min. Blood and liver samples were obtained for biochemical and histopathological examination. RESULTS: Treatment with enoxaparin decreased the histopathological abnormalities when compared with the control group. The highest levels of oxidative stress parameters were found in control group. The use of enoxaparin decreased the levels of all oxidative stress parameters, but the difference between the control and enoxaparin groups was not statistically significant. CONCLUSION: Enoxaparin ameliorated the harmful effects of high pressure CO2 pneumoperitoneum on the liver.

Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?

ABSTRACT Background The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies. Patients and Methods Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation. Exclusion criteria The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery. Results (1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) ...

Aminophylline Partially Prevents the Decrease of Body Temperature during Laparoscopic Abdominal Surgery

Aminophylline can elicit thermogenesis in rats or increase metabolic rate during cold stress in lambs. We tested the hypothesis that aminophylline would reduce the change in core body temperature during laparoscopic abdominal surgery requiring pneumoperitoneum. Fifty patients were randomly divided into an aminophylline group (n=25) and a saline control group (n=25). Esophageal temperature, index finger temperature, and hemodynamic variables, such as mean blood pressure and heart rate, were measured every 15 min during sevoflurane anesthesia. In the aminophylline group, esophageal temperatures at T45 (36.1+/-0.38 vs. 35.7+/-0.29, P=0.024), T60 (36.0+/-0.39 vs. 35.6+/-0.28, P=0.053), T75 (35.9+/-0.34 vs. 35.5+/-0.28, P=0.025), T90 (35.8+/-0.35 vs. 35.3+/-0.33, P=0.011), and T105 (35.8+/-0.36 vs. 35.1+/-0.53, P=0.017) and index finger temperatures at T15 (35.8+/-0.46 vs. 34.9+/-0.33, P<0.001), T30 (35.7+/-0.36 vs. 35.0+/-0.58, P=0.029), T45 (35.8+/-0.34 vs. 35.2+/-0.42, P=0.020), T60 (35.7+/-0.33 vs. 34.9+/-0.47, P=0.010), T75 (35.6+/-0.36 vs. 34.8+/-0.67, P=0.028), T90 (35.4+/-0.55 vs. 34.4+/-0.89, P=0.042), and T105 (34.9+/-0.53 vs. 33.9+/-0.85, P=0.024) were significantly higher than in the saline control group. Aminophylline is effective in maintaining the core temperature through a thermogenic effect, despite reduced peripheral thermoregulatory vasoconstriction.

Aminophylline Partially Prevents the Decrease of Body Temperature during Laparoscopic Abdominal Surgery

Aminophylline can elicit thermogenesis in rats or increase metabolic rate during cold stress in lambs. We tested the hypothesis that aminophylline would reduce the change in core body temperature during laparoscopic abdominal surgery requiring pneumoperitoneum. Fifty patients were randomly divided into an aminophylline group (n=25) and a saline control group (n=25). Esophageal temperature, index finger temperature, and hemodynamic variables, such as mean blood pressure and heart rate, were measured every 15 min during sevoflurane anesthesia. In the aminophylline group, esophageal temperatures at T45 (36.1+/-0.38 vs. 35.7+/-0.29, P=0.024), T60 (36.0+/-0.39 vs. 35.6+/-0.28, P=0.053), T75 (35.9+/-0.34 vs. 35.5+/-0.28, P=0.025), T90 (35.8+/-0.35 vs. 35.3+/-0.33, P=0.011), and T105 (35.8+/-0.36 vs. 35.1+/-0.53, P=0.017) and index finger temperatures at T15 (35.8+/-0.46 vs. 34.9+/-0.33, P<0.001), T30 (35.7+/-0.36 vs. 35.0+/-0.58, P=0.029), T45 (35.8+/-0.34 vs. 35.2+/-0.42, P=0.020), T60 (35.7+/-0.33 vs. 34.9+/-0.47, P=0.010), T75 (35.6+/-0.36 vs. 34.8+/-0.67, P=0.028), T90 (35.4+/-0.55 vs. 34.4+/-0.89, P=0.042), and T105 (34.9+/-0.53 vs. 33.9+/-0.85, P=0.024) were significantly higher than in the saline control group. Aminophylline is effective in maintaining the core temperature through a thermogenic effect, despite reduced peripheral thermoregulatory vasoconstriction.

Effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in rats

PURPOSE: To evaluate the effects of pneumoperitoneum with carbon dioxide and helium on renal function and morphology in a rat model. METHODS: Twenty four rats were randomized into three groups (n=8): gasless insufflation ('open', Pressure=0 mmHg), carbon dioxide pneumoperitoneum at 12 mmHg, and helium pneumoperitoneum at 12 mmHg; all lasting 90 minutes.. A cystostomy was performed and the bladder was emptied. At the end of the experiment, the urine produced, a blood sample and the left kidney of each animal were collected. The following variables were obtained: serum sodium, potassium, urea and creatinine, urine volume and creatinine. The creatinine clearance was estimated for each animal. The kidneys were stained with hematoxylin and eosin (HE) and evaluated by a pathologist blinded to the groups. RESULTS: The CO2 and Helium groups did not differ in the variables evaluated. Both developed oliguria (p<0.001 vs. gasless). The CO2 group presented hyperkalemia compared to gasless (p=0.05), which did not attain significance in the helium group. Histopathological analysis revealed mild hydropic degeneration and congestion in the three groups, with no significant difference among them. CONCLUSIONS: The type of gas resulted in no difference in the variables of renal function and morphology assessed. The increase in serum potassium was only observed with CO2 insufflation suggests a combined effect of elevated intra-abdominal pressure and metabolic effects of pneumoperitoneum.

Pneumoperitoneum induces morphological alterations in the rat testicle

PURPOSE:To investigate the seminiferous tubule histological morphology after an 8 mmHg pneumoperitoneum in the rat model. METHODS: Fourteen rats were divided into two groups: a Sham group submitted to anesthesia and a pneumoperitoneum (Pp) group submitted to abdominal insufflation at 8 mmHg during three hours, followed by desuflation. All rats were killed after six weeks, testicles were collected and evaluated for the tubule diameter, germinative epithelium height and Johnsen´s score. Means were compared by using the Student's-t-test. RESULTS:The seminiferous tubule diameter was diminished by 11.3% in the group submitted to pneumoperitoneum (p<0.05). No significant difference was found among the groups when analyzing the epithelium height and Johnsen´s score. CONCLUSION:In the rat model, the seminiferous tubules present structural alterations when subjected to pneumoperitoneum of 8 mmHg during three hours.

Does prolonged pneumoperitoneum affect the kidney? Oxidative stress, stereological and electron microscopy study in a rat model

Purpose: Pneumoperitoneum (Pp) at 12 to 15 mmHg in rats is associated with kidney damage. However, Pp at 8 mmHg is now known to best correlate to working pressures used in humans. Thus the aim of this work was to study the kidney of rats submitted to prolonged Pp at 8 mmHg. Materials and Methods: Rats were divided into a Sham group (n = 14), submitted to anesthesia, and a Pp group (n = 14), submitted to Pp at 8 mmHg, followed by deflation. In both groups, 7 animals were immediately killed and their kidneys were used for oxidative stress analyses. The remaining 7 rats in each group were evaluated after 6 weeks for the number of glomeruli and podocyte morphology. Results: For all analyzed parameters Sham and Pp groups presented no statistical difference. Conclusion: When submitted to adequate Pp pressures (8 mmHg), no kidney damage occurs in rats. .

Midgut volvulus after laparoscopic appendectomy / Volvo de intestino delgado após apendicectomia laparoscópica

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.

Relato do caso de uma criança de 13 anos de idade submetida à apendicectomia laparoscópica e que, no pós-operatório, desenvolveu quadro de obstrução intestinal, decorrente de um volvo de intestino delgado, na ausência de má rotação intestinal.

Evaluation of the effects of carbon dioxide pneumoperitoneum on abdominal wall wound healing in rats undergoing segmental resection and anastomosis of the left colon / Avaliação dos efeitos do pneumoperitônio com dióxido de carbono na cicatrização da parede abdominal de ratos submetidos à ressecção segmentar e anastomose no cólon esquerdo

PURPOSE: To evaluate the influence of carbon dioxide pneumoperitoneum on abdominal wall wound healing in rats. METHODS: Eighty rats underwent laparotomy, segmental left colon resection, and anastomosis. The animals were divided into three experimental groups and one control group: EI = pneumoperitoneum for 30 minutes before laparotomy (n=20); EII = pneumoperitoneum for 30 minutes after abdominal closure (n=20); EIII = pneumoperitoneum for 30 minutes before laparotomy and 30 minutes after abdominal closure (n=20); C = control group, without pneumoperitoneum (n=20). In each group, 10 animals were killed 7 days and 10 animals 14 days postoperatively. A segment of the abdominal wall was resected and subjected to tensile strength testing. Another segment of abdominal muscle was used for histopathological analysis; the specimens were fixed in formalin and stained with hematoxylin and eosin. RESULTS: There were no differences in histopathology and tensile strength values among animals in the experimental and control groups 7 or 14 days after surgery. CONCLUSION: Under the present experimental conditions, carbon dioxide pneumoperitoneum did not interfere with abdominal wall wound healing.

OBJETIVO: Avaliar a influência do pneumoperitônio com dióxido de carbono na cicatrização da ferida operatória na parede abdominal de ratos. MÉTODOS: Oitenta ratos foram submetidos à laparotomia, ressecção de segmento do cólon esquerdo e anastomose. Os animais foram distribuídos em quatro grupos de 20 ratos, três experimentais e um controle: Grupo EI = pneumoperitônio por 30 minutos antes da laparotomia. Grupo EII = pneumoperitônio por 30 minutos após a laparorrafia. Grupo EIII = pneumoperitônio por 30 minutos antes da laparotomia e 30 após a laparorrafia. Grupo C = controle, sem pneumoperitônio. Realizou-se, em cada grupo, a eutanásia de 10 animais no 7° e no 14° dia pós-operatório. Um segmento da parede abdominal foi ressecado e submetido à medida da resistência. Outro segmento muscular abdominal foi destinado à análise histopatológica, as peças foram fixadas em formol e as lâminas coradas com hematoxilina e eosina. RESULTADOS: Não houve diferença, à histopatologia e na força de ruptura, entre os animais dos grupos experimentais e do controle no 7° ou 14° dia pós-operatório. CONCLUSÃO: Nas condições em que o experimento foi realizado, o pneumoperitônio com dióxido de carbono não interferiu na cicatrização da parede abdominal.

Effects of carbon dioxide pneumoperitoneum on hepatic and renal morphology of rats after segmental colectomy and colonic anastomosis / Efeitos do pneumoperitônio com dióxido de carbono sobre a morfologia renal e hepática de ratos submetidos à colectomia segmentar e anastomose colônica

PURPOSE: To evaluate the effects of increased intraperitoneal pressure caused by carbon dioxide pneumoperitoneum on the hepatic and renal morphology of rats. METHODS: Fifty-four adult male rats were randomly divided into three groups (P, PP and C) after anesthesia: P - in 18 animals, pneumoperitoneum was established for 30 minutes immediately before laparotomy; PP - in 18 animals, pneumoperitoneum was established for 60 minutes divided into 30 immediately before laparotomy and 30 after abdominal closure; control group (C) - 18 animals underwent laparotomy without pneumoperitoneum induction. The pneumoperitoneum was maintained at a pressure of 5 mm Hg. Nine animals in each group were killed on the 3rd and 7th postoperative days, when kidney and liver samples were collected for morphological analysis. The liver specimens were stained with hematoxylin and eosin (HE), and the kidney specimens, with HE and von Kossa. Blinded examiners analyzed the slides. RESULTS: No changes in renal morphology were found. Liver samples showed histological signs of degeneration in animals in the pneumoperitoneum groups killed on the 7th postoperative day (p=0.029). CONCLUSION: The CO2 pneumoperitoneum did not affect renal morphology but caused hydropic degeneration in the liver of animals killed on the 7th postoperative day.

OBJETIVO: Avaliar os efeitos do aumento de pressão intraperitonial causada pelo pneumoperitônio com dióxido de carbono na morfologia renal e hepática de ratos submetidos à colectomia segmentar a anastomose colônica. MÉTODOS: 54 ratos machos da linhagem Winstar, que, após serem anestesiados, foram aleatoriamente distribuídos em três grupos (P, PP e C): P - 18 animais submetidos a pneumoperitônio por 30 minutos imediatamente antes da laparotomia PP - 18 animais submetidos a pneumoperitônio por 60 minutos, 30 imediatamente antes da laparotomia e 30 após a laparorrafia ; C - (grupo controle) - 18 animais submetidos à laparotomia sem o uso de pneumoperitônio. Os animais foram mortos no terceiro e sétimo dia pós-operatório, quando ocorreu a coleta do rim e parte do fígado. As peças foram coradas com Hematoxilina e Eosina e Von Kossa e analisadas por um patologista que desconhecia os grupos. RESULTADOS: Não foram observadas alterações nas estruturas renais. Nas amostras hepáticas foram observados achados histológicos como a degeneração hidrópica no grupo de animais mortos no sétimo DPO (p= 0,029). CONCLUSÃO: O pneumoperitônio com dióxido de carbono não afetou a morfologia renal e causou a degeneração hidrópica no fígado dos animais mortos no 7º dia pós-operatório.

Total oxidant status, total antioxidant status, and paraoxonase and arylesterase activities during laparoscopic cholecystectomy

INTRODUCTION: Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease; however, adverse hemodynamic changes induced by increased intraabdominal pressure due to pneumoperitoneum are known to occur. Herein, we investigated the effects of pneumoperitoneum on oxidative stress markers, including paraoxonase, arylesterase, total oxidant status, and total antioxidant status, during laparoscopic cholecystectomy. PATIENTS AND METHODS: Patients that underwent a laparoscopic cholecystectomy were classified as Group I, whereas patients that underwent surgical procedures for an abdominal wall hernia under general anesthesia were classified as Group II. Blood samples were obtained during the preoperative period, the perioperative period, and 24 hours after surgery (postoperative day 1). Leukocyte counts, neutrophil rates, paraoxonase activities, arylesterase activities, and total oxidant and antioxidant status levels were measured. RESULTS: The differences in leukocyte counts and neutrophil rates were not significant between the two groups. In Group I, no significant differences in the total oxidant and antioxidant status levels were identified; however, paraoxonase and arylesterase levels were lower on postoperative day 1. No significant changes were observed in the total oxidant status, total antioxidant status, and paraoxonase or arylesterase activities in Group II. The perioperative total antioxidant status and arylesterase level were higher in Group I in comparison to Group II. CONCLUSION: Paraoxonase and arylesterase levels are useful markers in the evaluation of oxidative stress caused by intraabdominal pressure due to pneumoperitoneum.

O uso do pneumoperitônio progressivo no pré-operatório das hérnias volumosas da parede abdominal / Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias

CONTEXTO: A correção das hérnias volumosas e dos grandes defeitos da parede abdominal constitui grande desafio da prática cirúrgica, em virtude das dificuldades técnicas e do alto índice de complicações respiratórias e cardiovasculares. OBJETIVOS: Apresentar experiência com a indução do pneumoperitônio progressivo no pré-operatório do tratamento cirúrgico das hérnias volumosas da parede abdominal. MÉTODOS: Estudo retrospectivo de seis pacientes que apresentavam hérnias volumosas da parede abdominal, e que foram operados após a instalação de um pneumoperitônio. O procedimento foi realizado através da colocação de um cateter na cavidade abdominal, na altura do hipocôndrio esquerdo, com insuflação de ar ambiente por período de 10 a 15 dias. RESULTADOS: Dos seis pacientes operados, quatro eram do sexo feminino e dois do masculino. A idade mínima era de 40 e a máxima de 62 anos. A duração da hérnia variou de 5 a 40 anos. Quatro pacientes tinham hérnia incisional, um umbilical e outro inguinal. O tempo médio de pneumoperitônio foi de 11,6 dias. Não houve complicações relacionadas à instalação e manutenção do pneumoperitônio. Todas as hérnias foram corrigidas sem dificuldades técnicas. Utilizou-se a técnica de Lichtenstein para a correção da hérnia inguinal, a transposição peritônio-aponeurótica para uma das hérnias incisionais, sendo as demais corrigidas com uso de tela de polipropileno. Um óbito e uma infecção de parede foram observados no pós-operatório dessas cirurgias. Não houve recidivas registradas até o momento, num período de seguimento de 4 a 36 meses. CONCLUSÃO: O pneumoperitônio progressivo pré-operatório é um procedimento seguro e de fácil execução, pois facilita o procedimento cirúrgico e diminui as complicações respiratórias e cardiovasculares no pós-operatório. É indicado para doentes com hérnias que perderam domicílio na cavidade abdominal.

CONTEXT: Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications. OBJECTIVES: To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall. METHODS: Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days. RESULTS: Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up. CONCLUSION: Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.

Innovative technique for the study of pneumoperitoneum in the evaluation of abdominal pain after chemical irritation with zymozan / Técnica original para o estudo da influência do pneumoperitônio na avaliação da intensidade da dor abdominal após irritação química com zimozan

PURPOSE: To assess the influence of pneumoperitoneum in mice submitted to peritoneal irritation provoked by the biological agent Saccharomyces cerevisae, by counting the number of abdominal contractions elicited. METHODS: To study the effects of pneumoperitoneum analgesic action, 60 mice were divided into two groups: the experimental group, subjected to pneumoperitoneum; and the control group, without pneumoperitoneum. The both groups received intraperitoneal injection of zymosan at a dose of 1mg/0,2ml/mouse. RESULTS: The sum of the number of abdominal contractions of the experimental group (with pneumoperitoneum) was significantly lower than that of the control group (without pneumoperitoneum). In the experimental group, a lower number of contractions occurred in each min compared to the control. CONCLUSION: The observation of the analgesic effect of pneumoperitoneum using CO2 in mice submitted to peritoneal irritation by zymosan was verified.

OBJETIVO: Avaliar a influência do pneumoperitônio em animais submetidos à irritação peritoneal provocada pelo agente biológico Saccharomyces cerevisae mediante a contagem do número de contrações abdominais. MÉTODOS: Para o estudo do efeito da ação analgésica do pneumoperitônio os 60 camundongos foram divididos em dois grupos, grupo experimento (com pneumoperitôneo) e controle (sem pneumoperitôneo). Os dois grupos receberam injeção intraperitoneal de zimosan na dose de 1mg/0,2ml/camundongo. RESULTADOS: O somatório do número de contrações abdominais do grupo experimento (com pneumoperitôneo) foi significativamente menor que no grupo controle (sem pneumoperitôneo). O número médio de contrações no grupo controle foi significativamente maior quando comparado com o grupo experimento. CONCLUSÃO: Observou-se efeito analgésico do pneumoperitônio com CO2 em animais submetidos à irritação peritoneal pelo zimosan.

Dissemination of bacteria labeled with technetium-99m after laparotomy and abdominal insufflation with different CO2 pressures on rats

PURPOSE: To asses the dissemination of bacteria labeled with technetium-99m (99mTc) from peritoneal cavity after different surgical procedures. METHODS: Bacteria of the Escherichia coli species labeled with 99mTc were used in a concentration of 10(8) units of colony-makers for ml (UFC/ml) and 1ml was inoculated through intra-peritoneal via. Forty-eight rats were divided into four groups: control, laparotomy, pneumoperitoneum with 10mmHg and pneumoperitoneum with 20mmHg of CO2. Procedures were performed 20 min after injection of the inoculum and lasted 30 min. Animals were sacrificed after six hours (Group 1) and 24 hours (Group 2). Samples of blood, liver and spleen were collected for radioactivity counting. RESULTS: After six hours, indirect detection of the bacteria in different organs was uniform in all groups. After 24 hours, a larger detection of technetium was observed in the livers of animals of the group insufflated with 20mmHg of CO2, when compared with those of control group (p<0.01). The other groups did not present statistically significant variations. CONCLUSIONS: The use of a higher intra-abdominal pressure was associated with a higher bacterial dissemination to the liver. The application of lower intra-abdominal pressures may be associated with a lower dissemination of the infectious status during laparoscopic approach of peritonitis status.

OBJETIVO: Avaliar a disseminação de bactérias marcadas com tecnécio-99m (99mTc) a partir da cavidade peritoneal após diferentes procedimentos cirúrgicos. MÉTODOS: Foram utilizadas bactérias da espécie Escherichia coli marcadas com 99mTc em uma concentração de10(8) unidades formadoras de colônia por ml (UFC/ml) sendo inoculado 1ml por via intra-peritoneal. Quarenta e oito ratos foram divididos em quatro grupos: controle, laparotomia, pneumoperitôneo com 10 mmHg e pneumoperitôneo com 20 mmHg de CO2. Os procedimentos foram realizados 20 minutos após a injeção do inóculo e duraram 30 minutos. Os animais foram sacrificados após seis horas (grupo 1) e 24 horas (grupo 2). Foram coletadas amostras de sangue, fígado e baço para contagem radioativa. RESULTADOS: Após seis horas, a detecção indireta das bactérias nos diferentes órgãos foi uniforme em todos os grupos. Após 24 horas, observou-se uma maior detecção de tecnécio nos fígados dos animais do grupo insuflado com 20 mmHg de CO2, quando comparados aos do grupo controle (p<0,01). Os outros grupos não apresentaram variações estatisticamente significativas. CONCLUSÕES: A utilização de pressões intra-abdominais mais elevadas associou-se a uma maior disseminação bacteriana para o fígado. A utilização de pressões intra-abdominais menos elevadas na abordagem da peritonite pode estar associada a uma menor disseminação do quadro infeccioso.

Influence of laparoscopy and laparotomy on gasometry, leukocytes and cytokines in a rat abdominal sepsis model

OBJETIVO: A cirurgia laparoscópica está associada com trauma reduzido e baixa resposta na fase aguda do trauma, quando comparada com a cirurgia aberta. As citocinas e o balanço ácido-base são fatores importantes da resposta biológica ao trauma cirúrgico-anestésico. O objetivo deste estudo foi determinar se o pneumoperitôneo com CO2 altera a expressão das citocinas, a gasometria e a contagem diferencial de leucócitos em ratos com sepse abdominal. MÉTODOS: Ratos Wistar foram aleatoriamente distribuídos em 5 grupos: controle (somente anestesia), laparotomia, pneumoperitôneo com CO2, ligadura e punção do ceco por laparotomia, ligadura e punção do ceco por laparoscopia. Após 30 minutos dos procedimentos, sangue arterial foi colhido para leucometria diferencial em hemocitômetro. TNFa, IL-1b e IL-6 foram dosadas no líquido intraperitoneal (por ELISA). Os parâmetros gasosos foram medidos no sangue arterial e nos exsudatos intraperitoneal e subperitoneal. RESULTADOS: Os valores de TNFa, IL-1b e IL-6 foram significantemente menores nos ratos submetidos ao pneumoperitôneo do que em todos os outros grupos (p<0.05). Expressão de TNFa, IL-1b e IL-6 foi menor no grupo sepse induzida por laparoscopia do que por laparotomia (p<0.05). Os ratos submetidos a ligadura e punção do ceco via laparoscópica desenvolveram acidose hipercárbica no sangue arterial e exsudato subperitoneal, mais intensa do que no grupo sepse laparotômica. Leucopenia e linfopenia foram mais acentuadas no grupo sepse laparoscópica (p<0.01). Entretanto, os animais submetidos a sepse laparotômica desenvolveram significante aumento de neutrófilos e eosinófilos quando comparados com os controles (p<0.05). CONCLUSÕES: Este estudo demonstrou que o pneumoperitôneo com CO2 contribuiu para reduzir a resposta inflamatória em ratos submetidos a modelo de sepse abdominal, no que diz respeito à expressão de citocinas intraperitoneais e leucometria diferencial. O pneumoperitôneo também contribuiu para instalação de acidose hipercárbica nos ratos sépticos.

Assessment of serum catecholamine concentrations in patients with pheochromocytoma undergoing videolaparoscopic adrenalectomy

INTRODUCTION: We analyzed the changes in serum catecholamine concentrations, i.e. adrenaline and noradrenaline, in response to surgical stress in patients with pheochromocytoma who undergone videolaparoscopic adrenalectomy. MATERIALS AND METHODS: Between January 1998 and March 2002, 11 patients underwent 12 videolaparoscopic adrenalectomies. In one case, the adrenalectomy was bilateral. Serum catecholamines were measured at 6 surgical times: T0: control before induction; T1: following the induction, laryngoscopy and intubation sequence; T2: after installing the pneumoperitoneum; T3: during manipulation-exeresis of the pheochromocytoma; T4: following ablation of the pheochromocytoma; T5: in the recovery room following intervention when the patient was extubated and was hemodynamically stable. RESULTS: Mean concentrations of serum noradrenaline were significantly different when the T0 and T2 surgical times were compared (T0: 3161 pg/mL; T2: 40440 pg/mL; p < 0.01), T0 and T3 (T0: 3161 pg/mL; T3: 46021 pg/mL; p < 0.001), T1 and T3 (T1: 5531 pg/mL; T3: 46021 pg/mL; p < 0.01), T2 and T4 (T2: 40440 pg/mL; T4: 10773 pg/mL; p < 0.01) and T3 and T5 (T3: 46021 pg/mL; T5: 2549 pg/mL; p < 0.001). Mean concentrations of serum adrenaline were significantly different when the T0 and T3 surgical times were compared (T0: 738 pg/mL; T3: 27561 pg/mL; p < 0.01). CONCLUSION: The pneumoperitoneum significantly increases serum noradrenaline concentrations, manipulation of the adrenal gland significantly increases the serum concentrations of noradrenaline and adrenaline, and the pheochromocytoma ablation significantly decreases serum noradrenaline concentrations.

Propranolol is effective in decreasing stress response due to airway manipulation and CO2 pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.

PURPOSE: to study the effect of Propranolol on hemodynamic response due to airway manipulation and carbon dioxide pneumoperitoneum on laparoscopic cholecystectomy cases. METHODS: 63 patients undergoing laparoscopic cholecystectomy under general anaesthesia were randomly divided into 3 groups; group 1 received 1.0 mg of Propranolol, group 2 received 0.5 mg of Propranolol and group 3 received 1 ml saline 5 minutes before induction of anaesthesia. Haemodynamic parameters were recorded for every 5 minutes from basal to 5 minutes after extubation and analyzed. RESULTS: Balanced anaesthesia used in our set up is effective in decreasing stress response due to airway manipulation (laryngoscopy and endotracheal intubation) but not effective in that due to CO2 pneumoperitoneum. Propranolol 1 mg 5 minutes before anaesthesia is effective in decreasing stress response due to airway manipulation and CO2 pneumoperitoneum in these groups of patients. CONCLUSION: Propranolol effectively blunts the stress response due to CO2 pneumoperitoneum during laparoscopic cholecystectomy.

Efeitos do pneumoperitônio sobre a hemodinâmica e função renais de cães ventilados com volume e pressão controlados / Effects of pneumoperitoneum on renal hemodynamics and function of dogs under volume and pressure-controlled ventilation

JUSTIFICATIVA E OBJETIVOS: Não existem estudos que associem os efeitos determinados pelas modalidades ventilatórias às repercussões renais durante o pneumoperitônio. O objetivo deste trabalho foi avaliar as alterações na hemodinâmica e função renais determinadas pelo pneumoperitônio em cães com ventilação a volume e pressão controlados. MÉTODO: Dezesseis cães anestesiados com tiopental sódico e fentanil foram divididos em Grupo 1, volume controlado e Grupo 2, pressão controlada e submetidos a pneumoperitônio de 10 e 15 mmHg. Foram estudados fluxo sangüíneo renal, resistência vascular renal, depuração de para-aminohipurato de sódio, sódio plasmático, potássio plasmático, osmolalidade plasmática, depuração de creatinina, fração de filtração, volume urinário, osmolalidade urinária, depuração osmolar, depuração de água livre, depuração de sódio, excreção urinária de sódio, excreção fracionária de sódio, depuração de potássio, excreção urinária de potássio, excreção fracionária de potássio. Os dados foram coletados em 4 momentos. M1, antes do pneumoperitônio; M2, 30 minutos após pneumoperitônio com 10 mmHg; M3, 30 minutos após pneumoperitônio com 15 mmHg; M4, 30 minutos após a deflação do pneumoperitônio. RESULTADOS: As depurações de para-aminohipurato de sódio e creatinina permaneceram constantes em ambos os grupos durante o experimento. Os valores plasmáticos do sódio e do potássio não se alteraram. Ocorreu diminuição a partir de M2 da depuração e da excreção fracionária de potássio em ambos os grupos. CONCLUSÕES: As modalidades ventilatórias não determinaram diferenças na hemodinâmica renal entre os grupos estudados. O pneumoperitônio, ocasionando compressão do parênquima renal, pode ter determinado alterações na reabsorção e/ou secreção do potássio.

Avaliação dos efeitos do pneumoperitônio laparoscópico com dióxido de carbono ou hélio sobre a perfusão esplâncnica: estudo experimental em cães / Evaluation of the laparoscopic pneumoperitoneum effect with carbon dioxide of helium over the splanchnic perfusion: experimental study in dogs

Para avaliar os efeitos do pneumoperitônio da laparoscopia na perfusão esplâncnica, foram realizadas medidas hemodinâmicas sistêmicas (PAM, FC, SaO2, PAP, PCP,PVC, DC), e loco-regionais (fluxo portal e tonometria gástrica), em 21 cães submetidos a insuflação abdominal por hélio ou CO2; bem como um grupo controle. Verificou-se que existem alterações significativas sistêmicas e loco-regionais, com pneumoperitônio de 30 mmHg, com elevação do PCO2-gap e queda do fluxo portal maiores no grupo CO2 do que no hélio. No entanto, no grupo insuflado com 15 mmHg com hélio, não ocorreram alterações por efeito mecânico do pneumoperitônio; mas no outro grupo, a absorção de CO2 promoveu elevação significativa da PCO2-gap./ Evaluation of the laparocopic pneumoperitoneum effect with carbon dioxide or Helium over the splanchnic perfusion: experimental study in dogs [thesis]. Faculdade de Medicina, Universidade de São Paulo; 2004. In order to establish the effects of the laparoscopic pneumoperitoneum at the splanchnic perfusion, sistemic hemodinamic measures (MAP, HR, SaO2, PAP, CWP, CVP, CO) as well as local-regional measures (portal flux and gastric tonometry) were performed in 21 dogs submitted to abdominal insufflation with Helium, CO2 and a Control group. Measurements showed that there were significant sistemic and locoregional alterations with 30 mmHg pneumoperitoneum with PCO2-gap elevation and portal flux decrease portal more significant in the CO2 group...