Effect of preoperative intravenous Ascorbic acid on serum levels of C - Reactive Protein as a marker of surgical stress response in laparoscopic gynaecological procedure under general anaesthesia.

Surgical stress is the systematic response to surgical injury and is characterized by activation of the sympathetic nervous system, endocrine responses as well as immunological and metabolic changes. In laparoscopic procedures intraperitoneal carbon dioxide insufflation and intraoperative organ handling also causes stress. As a result of these changes, plasma concentrations of neuroendocrine markers such as Cortisol, Glucagon, Insulin, Anti diuretic hormone and inflammatory immune markers such as C-Reactive Protein, Lactate, Catecholamines etc increases.

When this response is uncontrolled, it leads to postoperative complications like tachycardia, increased myocardial oxygen demand, tissue hypoxia, cellular acidosis, and poor long term outcomes like muscle wasting, impaired immune function and delayed wound healing, and if left unattended, organ failure and death.

Over the years many methods have been used to reduce the perioperative surgical stress response. These include using physiologic monitoring, providing balanced anaesthesia care and pain control, prescribing appropriate antibiotics, supporting patients by metabolic and nutritional means, and using new methods of imaging to aid in diagnosis.In pharmacological method of attenuating this surgical stress response variety of drugs have been studied, e.g.NSAIDS, Clonidine, Dexmedetomidine, opioids, Vitamin C etc. All of them show beneficial response to obtund the surgical stress response.

Out of these Vitamin C has shown a proven role in reducing the inflammatory response in sepsis. It stimulates the immune system in response to inflammation, by enhancing T-lymphocyte proliferation, which is postulated to be done by inhibition of signalling pathways involved in T cell apoptosis. This action leads to increased cytokine production and immunoglobulin synthesis. Ascorbic acid being structurally similar to glucose, helps in prevention of non-enzymatic glycosylation of proteins .Ascorbic acid’s anti-inflammatory properties are due to its hepatic messenger RNA expression of the tumour factors and interleukins downregulation.

Very few studies have studied the effect of intravenous vitamin C on acute stress response as the surgical stress response, showing benefits of pre-operative Vitamin C. But most of these studies are in western population.

 Hence, we have planned this study to evaluate the effect of preoperative intravenous ascorbic acid on surgical response in patients undergoing Diagnostic Hysterolaparoscopy surgery.