Evaluation of total oxidative and antioxidative status in pediatric patients undergoing laparoscopic surgery

doi:10.1016/j.jpedsurg.2008.11.031

Journal of Pediatric Surgery

Volume 44, Issue 7, July 2009, Pages 1367-1370

https://doi.org/10.1016/j.jpedsurg.2008.11.031 Get rights and content

Abstract

Objective

Reactive oxygen species (ROS) induced by several diseases can trigger oxidative stress. During laparoscopy, increased intraabdominal pressure caused by pneumoperitoneum may lead to splanchnic ischemia followed by reperfusion because of deflation. Because ischemia reperfusion creates oxidative stress, in this study, we aimed to investigate the oxidative-antioxidative status of the pediatric patients with laparoscopic surgery.

Methods

The children underwent laparoscopic procedures under general anesthesia, and they were mechanically ventilated. Blood samples were obtained after induction of anesthesia, at the end of the surgery, and were centrifuged at 3000 revolutions per minute for 10 minutes to separate plasma. The plasma total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were determined.

Results

Plasma TOS and OSI levels were significantly higher at the end of the surgery than after induction of anesthesia (P < .05 and P < .01, respectively). On the other hand, plasma TAS levels were lower in the end of the surgery than after induction of anesthesia (P < .05).

Conclusions

These results suggest that ROS are generated during the laparoscopic procedure, possibly as a result of an ischemia-reperfusion phenomenon induced by the inflation and deflation of the pneumoperitoneum, which causes oxidative stress and consume plasma antioxidants.

Section snippets

Methods

The study protocol was approved by the institutional review board. All parents gave their verbal and written informed consent. Thirty patients (mean age, 5 ± 2.52 years) with American Society of Anesthesiology I physical status, who were scheduled for elective laparoscopic appendectomy, were enrolled in the study. Patients with any metabolic, endocrine, hepatic, or renal diseases were excluded from the study.

The patients were premedicated with midazolam, 0.15 mg kg⁻¹, 30 minutes before the

Results

Demographic data that were matched for age, height, weight, duration of operation, and duration of anesthesia are shown in Table 1.

All patients were hemodynamically stable throughout the procedure and completed the study. There were no any significant worsening in heart rate, mean arterial pressure, end-tidal carbon dioxide, peripheral oxygen saturation, and respiratory rates (data not shown).

Plasma TOS and OSI levels were significantly higher at the end of the surgery than after induction of

Discussion

Pediatric laparoscopic surgeries are increasingly performed in the world. The possible unwanted side effect of these procedures remains unclear. This is the first study has been focused on the effects of laparoscopic procedures on the oxidative-antioxidative status of pediatric patients. Despite the limitation of our study to conduct a homogenous group including patients who underwent laparoscopic surgery, pediatric patients who had laparoscopic surgery for appendectomy operation have been

References (13)

ErelO.
A novel automated method to measure total antioxidant response against potent free radical reactions
Clin Biochem
(2004)
DesboroughJ.P.
The stress response to trauma and surgery
Br J Anaest
(2000)
ErelO.
A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation
Clin Biochem
(2004)
ErelO.
A new automated colorimetric method for measuring total oxidant status
Clin Biochem
(2005)
SivaciR. et al.
Cytotoxic effects of volatile anesthetics with free radicals undergoing laparoscopic surgery
Clin Biochem
(2006)
AhmedA.
Laparoscopic surgery in children—anaesthetic considerations
J Pak Med Assoc
(2006)

There are more references available in the full text version of this article.

Cited by (29)

Comparison of effects on the oxidant/antioxidant system of sevoflurane, desflurane and propofol infusion during general anesthesia
2015, Revista Brasileira de Anestesiologia
Desflurano e sevoflurano são usados com frequência para a manutenção da anestesia e estudos mostraram que esses anestésicos causam alterações variadas nos mecanismos de defesa antioxidante contra o estresse oxidativo. Este estudo teve como objetivo comparar os efeitos de anestesias com perfusão de sevoflurano, desflurano e propofol sobre os sistemas oxidante/antioxidante de pacientes submetidos à colecistectomia laparoscópica.
Foram incluídos no estudo 45 pacientes entre 18 e 50 anos, agendados para colecistectomia laparoscópica sob anestesia geral. Os pacientes foram divididos em três grupos para receberem propofol (Grupo P, n = 15), sevoflurano (Grupo S, n = 15) e desflurano (Grupo D, n = 15). Todos os grupos receberam 2 mg/kg de propofol IV, 1 mcg/kg de fentanil IV e 0,1 mg/kg de vecurônio IV para indução. Para manutenção da anestesia, o Grupo S recebeu ventilação com sevoflurano a 2%, o Grupo D recebeu desflurano a 6% e o Grupo P recebeu propofol em perfusões de 12 mg/kg/h nos primeiros 10 minutos, 9 mg/kg/h nos 10 minutos seguintes e 6 mg/kg/h subsequentemente. Antes da indução e depois da cirurgia, amostras de sangue venoso foram colhidas para avaliar os níveis de glutationa peroxidase e o total de oxidantes e antioxidantes.
Dos 45 pacientes incluídos no estudo, 22 eram do sexo masculino e 23 do feminino. As características demográficas dos grupos eram semelhantes. No período pós‐operatório, observamos que enquanto sevoflurano e propofol aumentaram os antioxidantes a um nível de significância estatística, desflurano aumentou o nível total de oxidantes em quantidade significativa, em comparação com os níveis pré‐operação.
Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy.
45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P, n = 15), sevoflurane (group S, n = 15) and desflurane (group D, n = 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 minutes, 9 mg/kg/h for the second 10 minutes and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants.
The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation.
N-acetylcysteine (NAC) protects against acute kidney injury (AKI) following prolonged pneumoperitoneum in the rat
2012, Journal of Surgical Research
Citation Excerpt :
A progressive increase of TBARS was observed in our study from 24 to 72 h following pneumoperitoneum in the untreated rats. A recent study with children submitted to laparoscopic surgery under general anesthesia and mechanically ventilated demonstrated an increase in total plasma oxidant status and a decrease in total antioxidant status, suggesting that reactive oxygen species are produced during laparoscopy and cause oxidative stress in these children [15]. In another study, with adult patients who underwent a laparoscopic cholecystectomy and who were compared with patients submitted to an abdomimal wall hernia surgery under general anesthesia, paraoxonase and arylesterase levels, markers of oxidative stress, were higher in the first group [16].
Acute kidney injury (AKI) following prolonged laparoscopy is a documented phenomenon. Carbon dioxide pneumoperitoneum induces oxidative stress. Previous experimental studies have shown that the antioxidant, N-acetylcysteine, protects the rat from AKI following ischemia-reperfusion. The aim of this study was to evaluate the effects of N-acetylcysteine (NAC) on rat renal function after prolonged pneumoperitoneum.
Normal rats treated or not with NAC were submitted to abdominal CO₂ insufflation of 10 mmHg, at short and long periods of time of 1 and 3 h, respectively, and evaluated at 24, 72 h, and 1 wk after deinsufflation. Glomerular filtration rate (GFR) was measured by inulin clearance and oxidative stress was evaluated by serum thiobarbituric acid reactive substances (TBARS)
No significant alterations in GFR were observed in normal animals submitted to the pneumoperitoneum of 1 h and evaluated after 24 h desufflation. With 3 h of pneumoperitoneum, a significant and progressive decrease in GFR occurred 24 and 72 h after desufflation with an increase in serum TBARS. GFR returned to normal levels a week later. In the NAC-treated rats, a complete protection against GFR drops was observed 24 and 72 h following 3 h of pneumoperitoneum associated with a decrease in TBARS.
These results suggest that NAC protects against acute kidney injury following prolonged pneumoperitoneum. These findings have significant clinical implications.
Increased oxidative stress and gut ischemia caused by prolonged pneumoperitoneum in patients undergoing robot-assisted laparoscopic radical prostatectomy
2011, Acta Anaesthesiologica Taiwanica
Citation Excerpt :
The detrimental effects of increased intra-abdominal pressure on the hepatic arterial, mesenteric, and intestinal mucosal blood flows have been described in several studies.4,5 An ischemia-reperfusion human model has been observed during and soon after laparoscopic surgery.6–9 After deflation of pneumoperitoneum, intra-abdominal pressure and splanchnic blood flow normalize, thereby representing the reperfusion phase.
To investigate changes in plasma oxidative stress markers associated with prolonged pneumoperitoneum during robot-assisted laparoscopic radical prostatectomy (RALP).
In all, patients of ASA Physical Status II–III who intended to undergo RALP were enrolled in the study. Arterial plasma levels of malondialdehyde (MDA) and intramucosal pH were measured 1 minute before and at 1 hour, 2 hours, 3 hours, and 4 hours after the introduction of pneumoperitoneum at an insufflation pressure of 15 mmHg; likewise, they were again measured every 10 minutes after deflation for 60 minutes, at 2 hours and 12 hours after deflation.
The mean duration of pneumoperitoneum was around 4 hours. After induction of pneumoperitoneum, the MDA concentrations were significantly elevated at various time points as compared with the preinsufflation value. Significant increase of MDA value was noted also 30 minutes after deflation as compared with the pre-deflation levels. The intramucosal pH value decreased significantly after CO₂ insufflation compared with the preinsufflation values. It also increased significantly 2 hours after CO₂ deflation as compared with the pre-deflation values.
A prolonged pneumoperitoneum in RALP results in decreased splanchnic blood flow. Pneumoperitoneum itself produces oxidative stress, and ischemia-reperfusion model after deflation of pneumoperitoneum produces more oxidative stress.
The influencer effect of Dexmedetomidine on radioiodine relevant to lacrimal gland impairment
2024, International Ophthalmology
Studying the surgical stress in open and laparoscopic treatment of inguinal hernia in children
2023, Pediatric Investigation
The Influencer Effect of Dexmedetomidine on Radioiodine Relevant to Lacrimal Gland Impairment Running Title: Dexmedetomidine on Radioionized Lacrimal Gland
2023, Research Square

View all citing articles on Scopus

View full text

Original articleEvaluation of total oxidative and antioxidative status in pediatric patients undergoing laparoscopic surgery

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Clin Biochem

Br J Anaest

Clin Biochem

Clin Biochem

Clin Biochem

Laparoscopic surgery in children—anaesthetic considerations

J Pak Med Assoc

Original article
Evaluation of total oxidative and antioxidative status in pediatric patients undergoing laparoscopic surgery