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    The effect of positive end-expiratory pressure on inflammatory cytokines during laparoscopic cholecystectomy
    (Saudi Med J, 2015) Yilmazlar, Firdevs; Karabayirli, Safinaz; Gzdemir, Muhammet; Usta, Burhanettin; Peker, Murat; Namuslu, Mehmet; Erdamar, Huesamettin
    Objectives: To investigate effects of the positive end-expiratory pressure (PEEP) application of 10 cm H2O on the plasma levels of cytokines during laparoscopic cholecystectomy. Methods: A prospective study was conducted on 40 patients who presented to the Department of General Surgery, Medical Faculty, Turgut Ozal University, Ankara, Turkey scheduled for laparoscopic cholecystectomy operation during a 10 month period from September 2012 to June 2013. Forty patients scheduled for laparoscopic cholecystectomy operation were randomly divided into 2 groups; ventilation through zero end-expiratory pressure (ZEEP) (0 cm H2O PEEP) (n = 20), and PEEP (10 cm H2O PEEP) (n = 20). All patients were ventilated with 8 ml/kg TV. Levels of interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, IL 10, and transforming growth factor (TGF)-beta 1 were measured in the pre- and post-operatively collected samples. Results: Blood samples of 30 patients' were analyzed for plasma cytokine levels, and 10 were excluded from the study due to hemolysis. Post-operative plasma IL-6 levels were observed to be significantly higher than the pre-operative patients (p = 0.035). Post-operative plasma TGF-beta 1 levels in the PEEP group was found significantly higher compared with the pre-operative group levels (p = 0.033). However, there were no significant differences in the pre- and post-operative plasma cytokine levels between the 2 groups. Conclusion: The application of PEEP of 10 cm H2O, which has known beneficial effect on respiratory mechanics, does not have any effect on systemic inflammatory response undergoing pneumoperitoneum during laparoscopic cholecystectomy surgery.