Comparison of Oxidative Stress Changes in Different Ventilation Strategies During Gynecologic Laparoscopic Surgery

NCT ID: NCT02512640

Last Updated: 2015-07-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

52 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-05-31

Study Completion Date

2014-07-31

Brief Summary

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Ischemia-reperfusion injury resulted from pneumoperitoneum during laparoscopic surgery have been reported in some literatures. There are no studies investigating the time course of changes in oxidative stress markers in volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) modes. The aim of this study is to compare the alterations in oxidative stress in two different ventilation strategies during gynecologic laparoscopic surgery.

Methods:

Fifty-two patients of ASA physical status I or II were randomly assigned to receive either VCV or PCV during laparoscopic gynecologic surgery. Blood gas analysis and ventilation variables were recorded 1 minute before (T1) and 1 hour after (T2) pneumoperitoneum. Blood samples for malondialdehyde (MDA) measurement were collected at seven points: 1 minute before (T1) and 1 hour after (T2) pneumoperitoneum; 30 minutes, 60 minutes, 90 minutes, and 120 minutes after deflation (T3\~T6); and 24 hours after deflation (T7).

Detailed Description

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Pneumoperitoneum during laparoscopic procedures greatly impairs splanchnic blood flow due to compression. Increased intra-abdominal pressure may elevate the diaphragm, increase intra-thoracic pressure, reduce functional residual capacity, and thus lead to atelectasis. In a collapsed lung, blood flow is decreased and reperfusion injury may subsequently occur during re-expansion of the lung. This ischemia-reperfusion injury results from the formation of reactive oxygen species (ROS), which are highly reactive intermediates of the oxygen metabolism. When there is an imbalance between ROS generation and removal by antioxidative mechanisms, oxidative stress occurs and eventually causes cellular and organ damage. Oxidative stress mediates tissue injury and may represent an important link between laparoscopy and clinical side effects. Malondialdehyde (MDA) is considered the most reliable marker of oxidative stress in the clinical setting. It is a breakdown product of lipid peroxidation in tissues. An elevated concentration of MDA reflects the level of lipid peroxidation.

Although there is abundant data comparing the effects of VCV and PCV during laparoscopic surgery, the time course of changes in oxidative stress in these two modes has not been elucidated. Therefore, the aim of this study was to compare the alterations of oxidative stress in two different ventilation modes, VCV and PCV, during gynecologic laparoscopic surgery. To this end, the investigators established a prospective randomized clinical study and measured the plasma levels of a lipid peroxidation marker at different stages.

Fifty-two patients of ASA physical status I or II were randomly assigned to receive either VCV or PCV during laparoscopic gynecologic surgery. During the operation, blood gas analysis and ventilation variables were recorded 1 minute before (T1) and 1 hour after (T2) the establishment of CO2 pneumoperitoneum in both groups. Blood samples for MDA measurement were collected at seven points: 1 minute before (T1) and 1 hour after (T2) pneumoperitoneum; at intervals of 30 minutes for 2 hours after the deflation of CO2 (T3\~T6); and 24 hours after the deflation of CO2 (T7). The samples were immediately centrifuged (1000g, 10 minutes) and the supernatants were stored at -800C until further analysis, which took place within 1 week. The investigators assessed the quality of recovery from anesthesia using a nine-item quality of recovery score (QoR Score) before operation and 24 hours after the deflation of CO2.

Conditions

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Reperfusion Injury Oxidative Stress

Keywords

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Pressure-controlled ventilation Volume-controlled ventilation Laparoscopy Oxidative stress

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Volume-controlled ventilation

Volume-controlled ventilation throughout the surgery

Group Type ACTIVE_COMPARATOR

Volume-controlled ventilation

Intervention Type PROCEDURE

a tidal volume of 8 ml/kg

Pressure-controlled ventilation

Pressure-controlled ventilation throughout the surgery

Group Type ACTIVE_COMPARATOR

Pressure-controlled ventilation

Intervention Type PROCEDURE

a peak airway pressure to maintain a tidal volume of 8 ml/kg

Interventions

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Volume-controlled ventilation

a tidal volume of 8 ml/kg

Intervention Type PROCEDURE

Pressure-controlled ventilation

a peak airway pressure to maintain a tidal volume of 8 ml/kg

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* aged between 20 and 70 years with a BMI \< 30 kg/m2 scheduled for laparoscopic gynecologic surgery requiring at least 1 hour of pneumoperitoneum

Exclusion Criteria

* cardiopulmonary disease and a history of sepsis or shock, findings suspicious of malignant disease, previous major abdominal operation, smoking, and recent antioxidant use (i.e. vitamins A, C and E).
Minimum Eligible Age

20 Years

Maximum Eligible Age

70 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Chang Gung Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Chia-Chih Liao, MD

Role: PRINCIPAL_INVESTIGATOR

Chang Gung Memorial Hospital

Locations

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Department of Anesthesiology, Chang Gung Memorial Hospital

Taoyuan District, Taiwan, Taiwan

Site Status

Countries

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Taiwan

References

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Sammour T, Mittal A, Loveday BP, Kahokehr A, Phillips AR, Windsor JA, Hill AG. Systematic review of oxidative stress associated with pneumoperitoneum. Br J Surg. 2009 Aug;96(8):836-50. doi: 10.1002/bjs.6651.

Reference Type BACKGROUND
PMID: 19591166 (View on PubMed)

Del Rio D, Stewart AJ, Pellegrini N. A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress. Nutr Metab Cardiovasc Dis. 2005 Aug;15(4):316-28. doi: 10.1016/j.numecd.2005.05.003.

Reference Type BACKGROUND
PMID: 16054557 (View on PubMed)

Kontoulis TM, Pissas DG, Pavlidis TE, Pissas GG, Lalountas MA, Koliakos G, Topouridou K, Sakantamis AK. The oxidative effect of prolonged CO(2) pneumoperitoneum a comparative study in rats. J Surg Res. 2012 Jun 15;175(2):259-64. doi: 10.1016/j.jss.2011.09.030. Epub 2011 Oct 12.

Reference Type BACKGROUND
PMID: 22172128 (View on PubMed)

Other Identifiers

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CGMH-IRB-102-0112A3

Identifier Type: -

Identifier Source: org_study_id