CO2 abdominal insufflation pretreatment increases survival after a lipopolysaccharide-contaminated laparotomy

Joseph M. Fuentes, Eric J. Hanly, Alexander R. Aurora, Antonio De Maio, Samuel P. Shih, Michael R. Marohn, Mark A. Talamini

Research output: Contribution to journalArticlepeer-review

Abstract

Carbon dioxide (CO2)-pneumoperitoneum is known to favorably modify the systemic immune response during laparoscopic surgery. The presented studies were designed to determine whether treating animals with CO2 abdominal insufflation before undergoing a lipopolysaccharide (LPS)-contaminated laparotomy would serve as "shock prophylaxis" and thus improve survival and attenuate cytokine production. Rats were randomized into five groups: CO2-pneumoperitoneum, helium-pneumoperitoneum, anesthesia control, laparotomy/LPS control, and LPS only control. Animals in the first four groups all received a laparotomy and a lethal dose of LPS. Immediately preceding their laparotomy, animals in the pneumoperitoneum groups received a 30-minute pretreatment of abdominal insufflation with either CO2 or helium. The anesthesia control group received a 30-minute pretreatment of isoflurane. Animal mortality was then recorded during the ensuing 72 hours. Subsequently, a similar protocol was repeated for measurements of cytokines. CO2-pneumoperitoneum increased survival at 48 hours compared with LPS control (P <.05), and decreased interleukin-6 plasma levels at 2 hours (P <.05). Abdominal insufflation with CO2 before the performance of a laparotomy contaminated with endotoxin increases survival and attenuates interleukin-6. The beneficial immune-modulating effects of CO 2-pneumoperitoneum endure after abdominal insufflation. CO 2-pneumoperitoneum pretreatment may improve outcomes among patients undergoing gastrointestinal surgery who are at high risk for abdominal fecal contamination.

Original languageEnglish (US)
Pages (from-to)32-38
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2006

Keywords

  • Carbon dioxide
  • Laparotomy
  • Pneumoperitoneum
  • Sepsis
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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