Effect of warmed, humidified insufflation gas and anti-inflammatory agents on cytokine response to laparoscopic nephrectomy: Porcine model

Purpose: We evaluated the effects of warmed, humidified CO₂ and anti-inflammatory agents on the local and systemic cytokine response after laparoscopic nephrectomy. Materials and Methods: A total of 15 pigs were randomized to undergo standard laparoscopic nephrectomy, laparoscopic nephrectomy with warmed, humidified CO₂ gas or laparoscopic nephrectomy with perioperative administration of intravenous dexamethasone and oral rofecoxib. At baseline, and 1, 4, 24 and 48 hours after surgery duplicate blood and peritoneal samples were drawn to analyze cortisol, glucose, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β and IL-6 via a microassay technique. Body temperature was determined at operation, intraoperatively and 1 hour postoperatively. Surgical parameters, including operative time, gas volume used and blood loss, were recorded. Results: Pigs in the warmed, humidified CO₂ and anti-inflammatory arms maintained higher intraoperative and postoperative core body temperatures than controls. Warmed, humidified CO₂ did not affect peritoneal or systemic cytokine levels. Peak peritoneal TNF-α levels in the anti-inflammatory group were significantly higher than in controls at 4 hours. Considerably higher serum TNF-α levels in the anti-inflammatory group were observed at 48 hours. Peritoneal IL-1β and IL-6 levels in the anti-inflammatory group remained similar to those in controls, while serum levels were noticeably lower. There was no observable difference in serum cortisol or the glucose response to laparoscopic nephrectomy among the groups. Conclusions: While preserving core body temperature, humidified, warmed CO₂ did not affect local or systemic trends of pro-inflammatory mediators. The administration of perioperative anti-inflammatory agents produced conflicting local and systemic cytokine response of uncertain clinical significance.