[Release of pro- and anti-inflammatory cytokines during different anesthesia procedures]

The modulation of immune functions, induced by trauma, surgical interventions and anaesthesia, is thought to play a crucial role in the development of post-traumatical or postoperative disorders. The balance of pro- and anti-inflammatory cytokines was shown to affect the outcome of the patients. This work studied the effects of different anaesthesiological procedures--total intravenous anaesthesia using Propofol/Sufentanil (TIVA) versus balanced inhalational anaesthesia using Trapanal/Sevoflurane (BIA) in patients with elective lumbal discectomia--on the secretion of various cytokines and their correlation to endocrine stress response. The concentrations of the pro-inflammatory cytokines IL-2, IL-6, IL-12 and IFN-gamma and their soluble receptor molecules as well as the concentrations of the anti-inflammatory cytokines IL-10, IL-1RA and TGF-beta were determined in plasma samples obtained pre-, intra- and postoperatively. Additionally, the plasma concentrations of the stress-related hormones cortisol, epinephrine and norepinephrine were measured. Changes in the cytokine profile were observed immediately after induction of anaesthesia. Significant differences were found particularly in IL-6 production as well as in the release of the soluble IL-2R alpha and the IL-1 receptor antagonist (IL-1RA). Whereas under BIA, the concentrations of IL-6 were found to be significantly elevated during the course of the study, the release of the soluble IL-2R alpha and the production of IL-1RA were reduced in this patient group in comparison to the TIVA group. The increase of the postoperative concentrations of cortisol, epinephrine and norepinephrine under BIA indicated enhanced activation of the hypothalamo-pituitary-adrenal axis and the sympathetic system. Thus, with respect to limitation of surgery-associated stress, total intravenous anaesthesia seems to have a favourable effect. Moreover, induction of the release of anti-inflammatory mediators under TIVA might contribute to the prevention of excessive postoperative inflammation. Taken together, these data suggest that the anaesthesiological management may have considerable influence on the postoperative inflammatory process. This might be of particular relevance for surgical interventions in patients after injuries, infections or malignant diseases which are known to be associated with immune dysfunction.