Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study

European Journal of Obstetrics & Gynecology and Reproductive Biology 161 (2012) 80–83

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Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study Turhan Aran a, Mesut A. Unsal a, Suleyman Guven a,*, Cavit Kart a, Esra Can Cetin a, Ahmet Alver b a b

Department of Obstetrics and Gynecology, Karadeniz Technical University, Trabzon, Turkey Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey

A R T I C L E I N F O

A B S T R A C T

Article history: Received 24 July 2011 Received in revised form 19 September 2011 Accepted 11 November 2011

Objective: To investigate the effect of carbon dioxide pneumoperitoneum on systemic oxidative stress by using serum oxidative stress markers (ischemia modified albumin (IMA), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI)) and to compare their effectiveness at clinically accepted safe intra-abdominal pressure levels (0.05 >0.05

Note: Values are expressed as mean  SD and (range).

T. Aran et al. / European Journal of Obstetrics & Gynecology and Reproductive Biology 161 (2012) 80–83

We observed significant increase in serum IMA levels at 30 min in laparoscopic surgery but there was no significant alteration in serum MDA, TOS, TAS and OSI levels. We think that IMA is a more sensitive marker than MDA, TOS, OSI and TAS for oxidative stress and IMA could show ischemic injury before reperfusion damage. A number of measures have been proposed to reduce oxidative stress caused by pneumoperitoneum. Intermittent gas releasing, gasless surgery and avoiding the head-up position are recommended simple measures to reduce hemodynamic compromise [23–25]. Pretreatment with verapamil and administration of erythropoietin and melatonin during surgery have found to be effective for minimizing the oxidative stress [26–28]. The mortality rate of laparoscopy has been reported as 4.4 per 100.000 laparoscopies. Although the mortality associated with laparoscopy is related to the extent and duration of the operative procedure, the major causes of death associated with laparoscopic operations are related to the complications of the procedure and anesthesia [1]. In one study, among 29 patients who died as a result of laparoscopic sterilization, 3 died of myocardial infarction [29]. We believe that the cause of death for these patients may be related to systemic oxidative stress induced by carbon dioxide pneumoperitoneum. Carbon dioxide pneumoperitoneum may cause systemic ischemia and release oxygen radicals which may be responsible for the detrimental effect of ischemia such as myocardial ischemia, shoulder pain etc. To our best of knowledge there is no study investigating and reporting serum marker of oxidative stress reflecting the effect of carbon dioxide pneumoperitoneum induced systemic oxidative stress in human study. From this point of view, our study may give a new insight to current knowledge of the literature by suggesting the use of new serum oxidative stress marker which may be used to monitor the carbon dioxide pneumoperitoneum induced systemic oxidative stress. In conclusion, this is the first clinical study investigating the effectiveness of serum IMA level in detection of the oxidative stressinducing effect of laparoscopic procedures. This study shows that even at safe IAP levels (