Modulation of inflammatory and immune response by vagal electrical stimulation in pigs underwent lung resection by thoracotomy or conventional robotic surgery.

• Grant number: 14/24526-4
• Support Opportunities: Regular Research Grants
• Start date: October 01, 2015
• End date: September 30, 2018
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Ricardo Mingarini Terra
• Grantee: Ricardo Mingarini Terra
• Host Institution: Hospital Sírio-Libanês. Sociedade Beneficente de Senhoras (SBSHSL). São Paulo , SP, Brazil
• Associated researchers: Daniel Ciampi Araujo de Andrade ; Eduardo Leite Vieira Costa ; Juliana Monte Real ; Luiz Fernando Lima Reis ; Manoel Jacobsen Teixeira ; Paulo Manuel Pêgo-Fernandes

Abstract

The thoracic surgery showed fast development after the Second World War. Initially, thoracotomy was option surgical access to the thoracic cavity. The extensive surgical trauma, and systemic inflammatory reaction and release of high blood levels of cytokines, C-reactive protein, interleukin 1, 6, and tumor necrosis factor, cause several complications in the postoperative period, such as chest pain, atelectasis, pneumonia , septic shock and multiple organ dysfunction. The video-assisted thoracic surgery was developed in order to minimize these complications, it has a lower inflammatory response. It was recently discovered anti-inflammatory neural pathway, wherein the electrical stimulation of the vagus nerve was able to modulate the release of cytokines heightened and consequently decrease the inflammatory response. OBJECTIVES: To determine whether electrical stimulation of the vagus nerve intraoperative thoracic surgery with pulmonary resection by thoracotomy or robotic surgery in pigs modulates the release of pro-inflammatory cytokines. The secondary objective is to evaluate the effects of vagal stimulation in immune function; tissue perfusion, hemodynamic and pulmonary function . The feasibility of measurements of electrical stimulation and will be tested in a pilot project in two animals. METHOD: An experimental study in pigs with four groups, Groups 1 and 2 with thoracotomy and Robotic Surgery Vagal Stimulation; Groups 3:04 thoracotomy and Robotic Surgery without vagal stimulation. Total of 24 animals, with 6 animals in each group. Throughout the experiment will collect data regarding the hemodynamic status of the animals. Electrical stimulation is performed before and after the parameters lobectomy 3.5mA Hz for 30 seconds every 5 minutes for 30 minutes (total of 7 stimulations). At the end of the surgery new electrical stimulation will be performed in the same settings. Blood samples will be collected at baseline of each animal and every 4 hours after the surgery to be completed 36 hours of postoperative monitoring. Assay of inflammatory mediators (IL-1± be analyzed, IL-1², IL-1ra, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-18, TNF ±, IFNg and GM-CSF) and also protein C reactiv. Os results for the measurement of cytokines will be analyzed using linear mixed models (longitudinal analysis) considering time (repeated analysis), sympathetic activation and path (and interaction between these last two). Procedural complications and other categorical variables will be evaluated using Fisher's exact test. Consider significant results whose p <0.05, we use the Stata 13 to run statistical analyzes. (AU)