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Background: Conflicting haemodynamic changes, suggested to be caused by vasopressin release, have been reported during carbon dioxide (CO2) pneumoperitoneum. However, peritoneal stimulations including open surgery cause both a systemic vasopressor response and a vasopressin release, which are suppressed by opiate administration. Also, a decreased venous return of blood to the heart causes vasopressin release. Furthermore, previous haemodynamic assessments of laparoscopic surgery have been conducted using various anaesthetic regimens, which are likely to have caused various haemodynamic effects. We hypothesised that intraoperative haemodynamic and/or humoral changes would not be observed in association with laparoscopic surgery provided that, (a) normovolaemia is continuously maintained using transoesophageal echocardiographic (TEE) assessment, and (b) adequate depth of general anaesthesia is continuously maintained by bispectral index (BIS) monitoring and high plasma Ievel opiate administration. Methods: Twenty ASA 1 women undergoing laparoscopic surgery received 10 ml · kg-1 lactated Ringer’s solution and thereafter were randomly allocated to receive intraoperatively either 8 ng · ml-1 or 4 ng · ml-1 plasma remifentanil concentrations while BIS was maintained at 50±5 by isoflurane alteration. The group receiving 4 ng · ml-1 remifentanil was used as control. Expired CO2 was maintained within a 32–38 kPa range throughout the investigation. Complete TEE haemodynamic investigation was performed before pneumoperitoneum (PP) (T1), and during PP horizontal (T2), with a head-up tilt (T3), with a head-down tilt (T4), horizontal (T5), and PP released (T6). Plasma vasopressin, epinephrine and norepinephrine levels were measured at T1, T3, and T6. ANOVA, Student’s t-test and Mann-Whitney U-test were used for statistical analysis. Results: Haemodynamic indices and humoral values did not change significantly within and between remifentanil groups throughout the investigation (all P<0.05). Conclusion: Continuous adequate depth of anaesthesia and normovolaemia may have prevented both a humoral and a haemodynamic response, initiated in the peritoneum by the contact with CO2 in previous investigations. [ABSTRACT FROM AUTHOR]

Previous studies have shown that desferrioxamine (DFX), an iron chelator preventing the synthesis of hydroxyl radical (OH.), up-regulates the cell-surface expression of tumour necrosis factor-α (TNF-α) receptors on unactivated human blood monocytes. In the present study, we investigated the regulatory action of DFX on 125I-TNF-α binding to monocytes upon exposure to bacterial lipopolysaccharide (LPS). Exposure to LPS (1 µg/ml) resulted in almost complete loss of 125I-TNF-α binding to the surface of monocytes. This down-regulation was reversible and the recovery observed after 18 hr was enhanced by addition of DFX (5 mM). However, binding studies on monocytes preexposed to low pH suggested that the DFX-induced increase of 125I-TNF-α binding was not due to differences in the number of receptors available but was probably due to a reduction of receptor occupancy by endogenously generated TNF-α. Time-course studies of TNF-α release from monocytes confirmed the ability of DFX to reduce the extracellular concentration of bioactive TNFα through a decrease of its synthesis and an increase of its inactivation. The latter process was associated with an increased expression of the soluble form of TNF-α receptor type II. These results indicate that, in the presence of LPS, DFX increases the release of soluble TNF-α receptors from monocytes. Thus, conversely, OH. generated in situ could reduce the shedding of soluble TNF-α receptors and, hence, increase the widespread release of bioactive TNF-α. [ABSTRACT FROM AUTHOR]