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- Title
Laparoscopic surgery and the parasympathetic nervous system.
- Authors
Fuentes, J. M.; Hanly, E. J.; Aurora, A. R.; De Maio, A.; Shih, S. P.; Marohn, M. R.; Talamini, M. A.
- Abstract
Background: Laparoscopic surgery preserves the immune system and has anti-inflammatory properties. CO2 pneumoperitoneum attenuates lipopolysaccharide (LPS)-induced cytokine production and increases survival. We tested the hypothesis that CO2 pneumoperitoneum mediates its immunomodulatory properties via stimulation of the cholinergic pathway. Method: In the first experiment, rats (n = 68) received atropine 1 mg/kg or saline injection 10 min prior to LPS injection and were randomization into four 30-min treatment subgroups: LPS only control, anesthesia control, CO2 pneumoperitoneum, and helium pneumoperitoneum. In a second experiment, rats (n = 40) received atropine 2 mg/kg or saline 10 min prior to randomization into the same four subgroups described previously. In a third experiment, rats (n = 96) received atropine 2 mg/kg or saline 10 min prior to randomization into eight 30-min treatment subgroups followed by LPS injection: LPS only control; anesthesia control; and CO2 or helium pneumoperitoneum at 4, 8, and 12 mmHg. In a fourth experiment, rats (n = 58) were subjected to bilateral subdiaphragmatic truncal vagotomy or sham operation. Two weeks postoperatively, animals were randomized into four 30-min treatment subgroups followed by LPS injection: LPS only control, anesthesia control, CO2 pneumoperitoneum, and helium pneumoperitoneum. Blood samples were collected from all animals 1.5 h after LPS injection, and cytokine levels were determined by enzyme-linked immunosorbent assay. Results: Serum tumor necrosis factor-α (TNF-α) levels were consistently suppressed among the saline-CO2 pneumoperitoneum groups compared to saline-LPS only control groups (p < 0.05 for all four experiments). All chemically vagotomized animals had significantly reduced TNF-α levels compared to their saline-treated counterparts (p < 0.05 for all), except among the CO2 pneumoperitoneum-treated animals. Increasing insufflation pressure with helium eliminated differences (p < 0.05) in TNF-α production between saline- and atropine-treated groups but had no effect among CO2 pneumoperitoneum-treated animals. Finally, vagotomy (whether chemical or surgical) independently decreased LPS-stimulated TNF-α production in all four experiments. Conclusion: CO2 pneumoperitoneum modulates the immune system independent of the vagus nerve and the cholinergic pathway.
- Subjects
LAPAROSCOPIC surgery; IMMUNE system; ENDOSCOPIC surgery; RADIOSCOPIC diagnosis; CYTOKINES; PARASYMPATHOMIMETIC agents; ANIMALS; ATROPINE; CARBON dioxide; SURGICAL diagnosis; LAPAROSCOPY; NERVE block; NEURONS; PARASYMPATHETIC nervous system; PARASYMPATHOLYTIC agents; RATS; TUMOR necrosis factors; VAGOTOMY; VAGUS nerve; NEURAL pathways; LIPOPOLYSACCHARIDES; CHEMICAL inhibitors; PHARMACODYNAMICS
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2006, Vol 20, Issue 8, p1225
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-005-0280-9