No effect of melatonin on oxidative stress after laparoscopic cholecystectomy: A randomized placebo-controlled trial
Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, Herlev, Denmark. Acta Anaesthesiologica Scandinavica
(Impact Factor: 2.32).
10/2010; 54(9):1121-7. DOI: 10.1111/j.1399-6576.2010.02294.x
Melatonin, an endogenous circadian regulator, also has antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the antioxidative effect of melatonin in patients undergoing laparoscopic cholecystectomy.
Patients were randomized to receive 10 mg melatonin or placebo during surgery. Blood samples for analysis of malondialdehyde (MDA), ascorbic acid (AA), total ascorbic acid (TAA) dehydroascorbic acid (DHA) and C-reactive protein (CRP) were collected pre-operatively and at 5 min, 6 h and 24 h after operation.
Twenty patients received melatonin and 21 patients received placebo during surgery. No significant differences were observed between the groups in the oxidative stress variables MDA, TAA, AA and DHA or in the inflammatory variable CRP (repeated-measures ANOVA, P>0.05 for all variables).
Administration of 10 mg melatonin did not reduce variables of oxidative stress in patients undergoing elective laparoscopic cholecystectomy.
Available from: Mahdi Alamili
- "AA, DHA and TAA were stabilized with 10% meta-phosphoric acid containing 2 mM disodium EDTA before storage. Both MDA and AA were analysed using a high pressure liquid chromatograph method as described previously , . "
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ABSTRACT: Circadian variation in bodily functions has been shown to impact health in acute and chronic medical conditions. Little is known about the relationship between circadian rhythm and sepsis in humans. We aimed to investigate circadian variations in the host response in a human endotoxaemia model.
A cross-over study, where 12 healthy young men received E. coli endotoxin (lipopolysaccharide, LPS) 0.3 ng/kg at 12 noon and, on another day, at 12 midnight. Blood samples were analysed for pro- and anti-inflammatory cytokines: tumour-necrosis factor (TNF)-alpha, soluble TNF receptors (sTNF-R)-1 and -2, interleukin (IL)-1beta, IL-1 receptor antagonist (IL-1Ra), IL-6, and IL-10 as well as YKL-40 and the oxidative stress markers malondialdehyde (MDA), ascorbic acid (AA) and dehydroascorbic acid (DHA) before and at 2, 4, 6 and 8 hours after LPS administration.
The levels of MDA and IL-10 where significantly higher during the day time (P<0.05) whereas levels of TNF-alpha, sTNF-RI, sTNF-RII, IL-1Ra, IL-6, and YKL-40 were higher (P<0.01 for all comparisons) during the night time. No significant differences were seen in the levels of AA and DHA.
A day-night difference in the acute phase response to endotoxaemia exists in healthy volunteers with a more pronounced inflammatory response during the night time. This circadian difference in the response to endotoxaemia may play an important role in the clinical setting and should be investigated further.
Available from: Saban Yalcin
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ABSTRACT: Objective: This study aimed to investigate the total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and the paraoxonase and arylesterase activities of patients with gallstones and compare them with healthy individuals as well as to assess the impact of sevoflurane and desflurane on ox-idative stress markers in laparoscopic surgery. Material and Methods: Forty patients scheduled for laparoscopic surgery (Patient Group) and 30 healthy volunteers as control subjects (Control Group) were enrolled in the study. The patient group was randomized to desflurane group (n= 0) and sevoflurane group (n= 20). Blood sam-ples were collected preoperatively and at postoperative 6 hours in order to measure the levels of TAS, TOS, OSI, and paraoxonase and arylesterase activities. Preoperative and postoperative laboratory findings of sevoflurane and desflurane group were compared with the Mann Whitney U test between groups and the Wilcoxon test within a group. Results: Preoperative TOS, OSI levels in the patient group were significantly increased and ary-lesterase activities were significantly decreased compared to the control group (p<0.05) [(TOS (μmol H2O2 equ- iv/L), 19.64 ± 2.16 vs. 14.25 ± 1.83), (OSI 1.85 ± 0.53 vs. 0.98 ± 0.24), (Arylesterase (U/L), 45.19 ± 6.82 vs. 49.66 ± 4.78)]. There was no statistically significant difference between sevoflurane and desflurane group in laboratory findings of the preoperative and the postoperative period (p> 0.05). Preoperative and postoperative TAS, TOS, OSI results and activities of paraoxonase and arylesterase were not significantly different in the sevoflurane gro-up (p> 0.05). Although the preoperative and postoperative levels of TAS and TOS and paraoxonase and aryles-terase activities in the desflurane group was not significantly different, postoperative OSI was significantly increased (p< 0.05) (OSI 1.80 ± 0.57 vs 2.20 ± 0.67). Conclusion: Patients with gallstone are exposed to a potent oxidative stress influencing TOS, OSI levels and arylesterase activities. Sevoflurane and desflurane had similar effects on oxidative stress during laporoscopic surgery in this patient group; however, OSI was increased in the desflurane group in the postoperative period compared to preoperative levels (p< 0.05).
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ABSTRACT: This systematic review aims to synthesize the data on the effectiveness of pharmacological modulation of stress response in minimally invasive surgery. Eligible trials were clinical trials randomized or not or experimental trials that investigated the effect of pharmacological agents on modulation of surgical stress response to minimally invasive surgery. No clinical trials were identified. Eight experimental trials met the inclusion criteria and were obtained in full text. Experimental models were rats or rabbits subjected to pneumoperitoneum, or pneumoretroperitoneum, not to a whole operation. Pharmacological modulation of surgical stress response was attempted with erythromycin, melatonin, mesna, verapamil, pentoxifylline, N-acetylcysteine, and zinc. All the pharmacological agents, except pentoxifylline, seemed to reduce oxidative stress markers. However, only mesna pretreatment prevented oxidative stress, because oxidative stress markers remained in the sham levels. Contrasting data were obtained for pentoxyphilline. In conclusion, available data suggest that pharmacological modulation of surgical stress response to minimally invasive surgery might be feasible.
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