Carbon dioxide pneumoperitoneum–mediated attenuation of the inflammatory response is independent of systemic acidosis

• Published in: Surgery Vol. 137; no. 5; pp. 559 - 566
• Main Authors: Hanly, Eric J., Bachman, Sharon L., Marohn, Michael R., Boden, John H., Herring, Aimee E., De Maio, Antonio, Talamini, Mark A.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.05.2005; Elsevier
• Subjects: Abdomen; Acidosis - chemically induced; Acidosis - metabolism; Acidosis - pathology; Acute-Phase Proteins - metabolism; Animals; Biological and medical sciences; Carbon Dioxide - adverse effects; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Laparoscopy - adverse effects; Liver - metabolism; Liver - pathology; Male; Medical sciences; Neutrophil Infiltration; Other diseases. Semiology; Pneumoperitoneum, Artificial - adverse effects; Rats; Rats, Sprague-Dawley; Sepsis - etiology; Sepsis - metabolism; Sepsis - pathology; Medicine; Metabolic disorder; Treatment; Pneumoperitoneum; Abdominal disease; Surgery; Carbon dioxide; Inflammation; Systemic; Acid base balance disorder; Disseminated; Acidosis
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2005.01.005

The purpose of this study was to determine if systemic acidosis induced by peritoneal absorption of carbon dioxide (CO 2) during laparoscopy plays a role in CO 2 pneumoperitoneum–mediated attenuation of the acute phase inflammatory response associated with perioperative sepsis. The influence of hepatic polymorphonuclear (PMN) leukocyte infiltration on this phenomenon was also investigated. Forty-five rats were randomized into 5 groups: anesthesia control, open cecal ligation and puncture (OCLP), laparoscopic cecal ligation and puncture using helium for insufflation (He LCLP), LCLP using CO 2 with continued spontaneous ventilation (LCLP-SV), and LCLP using CO 2 with intubation and positive pressure ventilation (LCLP-PPV). After 30 minutes, arterial blood gas parameters remained normal in control, OCLP rats, and He LCLP rats, while CO 2 LCLP-SV rats developed significant hypercarbic acidosis. This acidosis was corrected in CO 2 LCLP-PPV rats ( P < .0001 vs CO 2 LCLP-SV for both). Expression of the rat acute phase gene α 2-macroglobulin was greater after OCLP and He LCLP than after either CO 2 LCLP-SV or CO 2 LCLP-PPV ( P < .0001 vs either CO 2 OCLP-SV for both). However, levels of α 2-macroglobulin were not significantly different between the acidotic (LCLP-SV) and normocarbic (LCLP-PPV) CO 2 groups. Infiltration of the hepatic parenchyma by PMNs did not differ significantly between groups. CO 2 insufflation–induced systemic acidosis is not responsible for the reduction in the acute phase inflammatory response observed in laparoscopic animal models of sepsis. Hepatic PMN infiltration also does not appear to mediate this effect.