Zubeyir CEBECİ, Betül KOZANHAN, Hüseyin KURKU, Sadik OZMEN

Effect of alveolar recruitment maneuver on ischemia-modified albumin and oxidative stress in laparoscopic cholecystectomy

The effect of intraoperative recruitment maneuver on ischemia-modified albumin (IMA) and oxidative stress in performed laparoscopic cholecystectomy with intraabdominal 12 mmHg pressure was investigated. Fifty patients undergoing laparoscopic cholecystectomy were included in the study by separating the two groups. Basal ventilator settings in both groups were set as tidal volume: 6-8 ml / kg, respiratory rate: 12 breaths / min, I: E = 1: 2, flow: 4 l / min. In group R, after intubation, 5 cm H2O PEEP was adjusted in addition to basal ventilator settings. Five minutes after CO2 insufflation and exsufflation, PEEP was step by step raised to 10-15-20 cm H2O, and patients were ventilated for 10 breaths. Venous blood samples were taken from the patients for three times in perioperative periods to measure IMA and oxidative stress. There was no difference between the groups in terms of demographic data, surgery and insufflation times. Significant differences in IMA,TOS,TAS and OSI levels within the group were observed but no difference was between groups. The recruitment maneuver that we used in laparoscopic cholecystectomies was found to have no effect reducing tissue ischemia and oxidative stress response in the intraoperative period.

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Safran DB, Orlando R, 3rd. Physiologic effects of pneumoperitoneum. Am J Surg. 1994;167:281-6.

Ibraheim OA, Samarkandi AH, Alshehry H, et al. Lactate and acid base changes during laparoscopic cholecystectomy. Middle East J Anaesthesiol. 2006;18:757-68.

Leduc LJ, Mitchell A. Intestinal ischemia after laparoscopic cholecystectomy. JSLS. 2006;10:236-8.

Ozmen MM, Kessaf Aslar A, Besler HT, et al. Does splanchnic ischemia occur during laparoscopic cholecystectomy? Surg Endosc. 2002;16:468-71.

Oti DC, Mahendran DM, Sabir DN. Anaesthesia for laparoscopic surgery. Br J Hosp Med. 2016;77:24-8.

Pelosi P, Foti G, Cereda M, et al. Effects of carbon dioxide insufflation for laparoscopic cholecystectomy on the respiratory system. Anaesthesia. 1996;51:744-9.

Atkinson TM, Giraud GD, Togioka BM, et al. Cardiovascular and Ventilatory Consequences of Laparoscopic Surgery. Circulation. 2017;135:700-10.

Almarakbi WA, Fawzi HM, Alhashemi JA. Effects of four intraoperative ventilatory strategies on respiratory compliance and gas exchange during laparoscopic gastric banding in obese patients. Br J Anaesth. 2009;102:862-8.

Celebi S, Koner O, Menda F, et al. The pulmonary and hemodynamic effects of two different recruitment maneuvers after cardiac surgery. Anesth Analg. 2007;104:384-90.

Futier E, Constantin JM, Pelosi P, et al. Intraoperative recruitment maneuver reverses detrimental pneumoperitoneum-induced respiratory effects in healthy weight and obese patients undergoing laparoscopy. Anesthesiol. 2010;113:1310-9.

Tusman G, Bohm SH, Vazquez de Anda GF, et al. ‘Alveolar recruitment strategy’ improves arterial oxygenation during general anaesthesia. Br J Anaesth. 1999;82:8-13.

Whalen FX, Gajic O, Thompson GB, et al. The effects of the alveolar recruitment maneuver and positive end-expiratory pressure on arterial oxygenation during laparoscopic bariatric surgery. Anesth Analg. 2006;102:298-305.

Derikx JP, Schellekens DH, Acosta S. Serological markers for human intestinal ischemia: A systematic review. Best Pract Res Clin Gastroenterol. 2017;31:69-74.

Köksal H, Kurban S, Şahin M. Laparoskopik kolesistektomi süresince splanknik sahadaki hemodinamik değişikliklerin değerlendirilmesinde iskemi modifiye albuminin rolü. Turk J Surg. 2010;26:091-4.

Sbarouni E, Georgiadou P, Kremastinos DT, et al. Ischemia modified albumin: is this marker of ischemia ready for prime-time use? Hellenic J Cardiol. 2008;49:260-6.

Diebel LN, Wilson RF, Dulchavsky SA, et al. Effect of increased intraabdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. J Trauma. 1992;33:279-82.

Eleftheriadis E, Kotzampassi K, Botsios D, et al. Splanchnic ischemia during laparoscopic cholecystectomy. Surg Endosc. 1996;10:324-6.

Jakimowicz J, Stultiens G, Smulders F. Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc. 1998;12:129-32.

Eleftheriadis E, Kotzampassi K, Papanotas K, et al. Gut ischemia, oxidative stress, and bacterial translocation in elevated abdominal pressure in rats. World J Surg. 1996;20:11-6.

Aran T, Unsal MA, Guven S, et al. Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study. Eur J Obstet Gynecol Reprod Biol. 2012;161:80-3.

Glantzounis GK, Tselepis AD, Tambaki AP, et al. Laparoscopic surgeryinduced changes in oxidative stress markers in human plasma. Surg Endosc. 2001;15:1315-9.

Koksal H, Kurban S. Total oxidant status, total antioxidant status, and paraoxonase and arylesterase activities during laparoscopic cholecystectomy. Clinics (Sao Paulo, Brazil). 2010;65:285-90.

Polat C, Yilmaz S, Serteser M, et al. The effect of different intraabdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy. Surg Endosc. 2003;17:1719-22.

Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem. 2005;38:1103-11.

Ghiselli A, Serafini M, Natella F, et al. Total antioxidant capacity as a tool to assess redox status: critical view and experimental data. Free Radic Biol Med. 2000;29:1106-14.

Davarci I, Karcioglu M, Tuzcu K, et al. Evidence for negative effects of elevated intra-abdominal pressure on pulmonary mechanics and oxidative stress. Scientific World Journal. 2015;2015:612642.

Koksal GM, Sayilgan C, Aydin S, et al. The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy. Eur J Anaesthesiol. 2004;21:217-20.

Duggan M, McNamara PJ, Engelberts D, et al. Oxygen attenuates atelectasisinduced injury in the in vivo rat lung. Anesthesiol. 2005;103:522-31.

Severgnini P, Selmo G, Lanza C, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiol. 2013;118:1307-21.