Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study

Eur J Obstet Gynecol Reprod Biol. 2012 Mar;161(1):80-3. doi: 10.1016/j.ejogrb.2011.11.027. Epub 2011 Dec 3.


Objective: To investigate the effect of carbon dioxide pneumoperitoneum on systemic oxidative stress by using serum oxidative stress markers (ischemia modified albumin (IMA), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI)) and to compare their effectiveness at clinically accepted safe intra-abdominal pressure levels (<12 mmHg).

Study design: A total of 33 consecutive patients who had a unilateral ovarian cyst were enrolled for this prospective clinical study. All women underwent a laparoscopic ovarian cystectomy procedure. Venous blood was collected from patients preoperatively, 10 min after induction of anesthesia and 30 min after insufflation. Preoperative, 10(min), and 30(min) serum IMA, MDA, TOS, OSI and TAS levels were compared.

Results: The mean age was 29.3 ± 6.4 and the range of operation time was 45-80 min. The mean serum IMA levels showed a significant increase 30 min later from CO(2) insufflation (p<0.05). Significant alterations were not observed in serum MDA, TOS, OSI or TAS levels.

Conclusions: Laparoscopic surgery causes systemic ischemia and this ischemic effect can be revealed by measuring serum ischemia modified albumin. IMA is more sensitive than MDA, TOS, OSI and TAS in early detection of systemic oxidative stress.

MeSH terms

  • Adult
  • Antioxidants
  • Biomarkers / blood
  • Carbon Dioxide*
  • Female
  • Humans
  • Insufflation
  • Laparoscopy / adverse effects
  • Laparoscopy / methods
  • Malondialdehyde / blood
  • Oxidants / blood
  • Oxidative Stress*
  • Pneumoperitoneum, Artificial / adverse effects*
  • Serum Albumin
  • Serum Albumin, Human


  • Antioxidants
  • Biomarkers
  • Oxidants
  • Serum Albumin
  • ischemia-modified albumin
  • Carbon Dioxide
  • Malondialdehyde
  • Serum Albumin, Human