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- W2890199334 abstract "Minimally invasive surgery (MIS) has been increasingly used and the continuousdevelopment of technology and instruments allowed the application of this surgicalapproach, not only in adults, but also in paediatric and neonatal patients to correct severalbirth defects. Since the beginning of its application in adult patients, several studies on thehemodynamic, metabolic and inflammatory changes during MIS are being extensivelyperformed, with a special focus on the effects of CO2-insufflation. More recently, concernsabout the impact of the CO2-insufflation over the developing organs and organ systems ofneonates have been published, with brain oxygenation and perfusion the most investigatedevents. In this thesis, we aimed to unravel some of these issues and contribute to theunderstanding of the impact of the thoracic and peritoneal CO2-insufflation in this sensitivephase of life, that is the neonatal period.Surgery leads to specific endocrine, immunologic and metabolic changes but, during MIS,the isolated impact of CO2-insufflation on these parameters is limited. Studies on animalmodels arose as a methodical way to evaluate the impact of CO2-insufflation, by avoidingconfounding factors associated with human studies. Nevertheless, most studies areperformed in adult animals, with only a few studying these impacts on neonatal models.Additionally, many studies are performed without ventilatory support which is the key playerfor the maintenance of normal blood gas partial pressures and pH during CO2-insufflation.In this work we developed an intubation technique that could be applied in neonatal rats,allowing respiratory support during CO2-pneumoperitoneum and -pneumothorax. Theadjustments in ventilatory parameters allowed the development of a neonatal animal model of CO2-pneumothorax and CO2-pneumoperitoneum, which was then used to evaluate acuteand long-term impact of CO2-insufflation over neonatal organ systems.In our anesthetized, endotracheal intubated, mechanically ventilated neonatal rat model, theimpact of the CO2-insufflation over the immune system was evaluated at different levels. Theimpact of CO2-insufflation over immune cell populations was evaluated immediately afterCO2-pneumothorax and 4 weeks after exposure, and no major alterations were detectedwhen compared to control animals, suggesting that CO2-insufflation do not exert a significantimpact on cellular immune system balance. But when evaluating peripheral (serum) andcentral (cerebrospinal fluid [CSF]) cytokine response, our findings support that the oldparadigm of an immunologically privileged CNS may not be sustained perioperatively duringMIS surgery, since increased anti-inflammatory cytokine IL-10 levels in CSF were found inanimals submitted either to CO2-pneumothorax or CO2-pneumoperitoneum. The impact ofthis finding in the developing brain is still unclear, and further study is needed.It is known that a single developmental insult in the neonatal period can initiate a cascadeof…" @default.
- W2890199334 created "2018-09-27" @default.
- W2890199334 creator A5044922940 @default.
- W2890199334 date "2018-03-19" @default.
- W2890199334 modified "2023-10-05" @default.
- W2890199334 title "Studies on thoracic and peritoneal CO2-insufflation in neonatal rats: 2 implications for minimally invasive neonatal surgery" @default.
- W2890199334 hasPublicationYear "2018" @default.
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