Full Conditioning

Acute Inflammation

Acute Inflammation

In order to perform surgery the tissues have to be visible and thus exposed to the either ambient air in open surgery or to a CO2 pneumoperitoneum during laparoscopic surgery.
This results in acute inflammation of the entire peritoneal cavity (or other cavities lined with a mesothelium). This effect increases with the duration of the pneumoperitoneum or the exposure to the air. The acute inflammation is increased by other detrimental factors such as desiccation, surgical trauma, fibrin deposition and others.
This acute inflammation is the most important cause of postoperative pain, and of adhesion formation. It is some 20 times more important than the surgical trauma itself.
Full-conditioning prevents this trauma and the consequences of this trauma, by a series of interventions.

The right gas environment

The single most important in the prevention of superficial cell damage and acute inflammation is the addition of small amounts of N2O to the CO2 pneumoperitoneum, as done with the pain conditioner.
The mechanism is unknown.

Cooling & humidifying

The second most important is cooling (with a third means) and humidifying.
At a temperature below 30°C the cellular metabolism is slowed down and cells become more resistant to any metabolic trauma such as a decreased or increased oxygen tension, desiccation, pH changes or the irritation of CO2, fibrin deposition or inappropriate rinsing liquids
We demonstrated that the abdominal cavity can be safely cooled to 25°C without affecting the core body temperature.
Cooling should be performed by a third means and cannot be performed by the insufflated gas. The enthalpy of gas too low to cool and more important is that gas insufflated at a lower temperature will be heated up in the abdomen with desiccation as an unavoidable consequence.

Other Products

Acute inflammation after surgery, and thus pain and adhesions, will also decrease by preventing fibrin deposition (by using heparin in the rinsing solution), by giving dexamethasone at the end of surgery and many others.
These factors have been clearly demonstrated to be effective in animal experiments but failed to become demonstrated in the human surgery. This however is not surprising since the inherent variability of human surgery necessitates prohibitive large series to reach statistical significance.

Full-conditioning

Today full-conditioning, ie the combination of all these factors which can be used without risk or side effects, results in unprecedented postoperative pain relief and adhesion prevention as demonstrated in the human. In addition other advantages ad a reduced cancer metastasis are expected : these were experimentally demonstrated but not yet proven in the human
Full-conditioning is therefore expected to become an important reduction of the cost of health care