The effect of intraoperative different oxygen inspiration rate on lung glycocalyx damage in laparoscopic surgery

Aim: The aim of this study was to ventilate the patients undergoing laparoscopic lower abdominal surgery with different inspiratory oxygen fraction and to investigate the effect of this difference on glycocalyx. Method : This randomized controlled study was performed in patients undergoing laparoscopic lower abdominal surgery after approval of the Ethics Committee and patient consent. Eighty patients with physical status score ASA I-III, body mass index (BMI) <35 kg / m2, age range 18-70 were included in the study. Blood samples were taken before induction. After induction, different inspiratory oxygen fractions (Group 1, FiO2 = 0.35, Group 2, FiO2 = 0.80) were administered to the randomized two groups. Arterial and venous blood gases were collected 10 minutes after intubation. Systolic, diastolic, mean blood pressure , heart rate , peripheral oxygen saturation , end-tidal CO2 and PEAK values were recorded during the operation. At the end of the operation, arterial and venous blood were taken from the patients after extubation. Total protein, Sindecan-1, Surfactant protein -A, IMA (ischemia modified albumin), Sialic acid, TNF-α were analyzed in the serum samples. Results: A total of 76 patients were evaluated.There was a significant increase in the pre- and post-operative syndecan values in the group with low-inspired oxygen fraction (p <0,05). There was a significant difference between the two groups in favor of the high inspiration oxygen fraction at the end of the operation (p <0,05).There was a significant increase in the surfactant A values before and after the operation in the group with low-inspiring oxygen fraction (p <0.05). A significant difference was found between the two groups in favor of the high inspiration oxygen fraction in the surfactant protein A values VI measured at the end of the operation. (p <0.05) There was a significant increase in preoperative and postoperative sialic acid values in the group with low-inspiring oxygen fraction. There was a significant difference between the two groups in favor of high inspiration oxygen fraction at the end of the operation. (p <0.05). The increase in TNF-α values was lower in the low-inspiring oxygen fraction group. There was a significant difference between the two groups in favor of low inspiration oxygen fraction at the end of the operation. ( p<0,05) Conclusion: High inspiratory oxygen fraction application during the operation was found to have a protective effect on glycocalyx compared to the low oxygen fraction. Whether this finding will require a general paradigm shift should be tested with further studies.