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Published on: October 20, 2012
Effect of 2 anesthetic techniques on the postoperative proinflammatory and anti-inflammatory cytokine response and
Christine E Schneemilch1, Annelore Ittenson, Siegfried Ansorge
1Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, 39120 Magdeburg, Germany. christine.schneemilch@medizin.uni-magdeburg.de
Study Objective:
The aim of this study was to investigate the influence of 2 established anesthetic techniques: total intravenous anesthesia and balanced inhalation anesthesia (BAL) on the perioperative-induced changes of peripheral blood mononuclear cells (PBMCs), changes in lymphocyte subsets, and the balance of proinflammatory and anti-inflammatory cytokines.
Design:
This is a prospective, randomized, clinical comparison study.
Settings:
This study was set at a university hospital.
Patients:
This study involved 50 patients with American Society of Anesthesiologists physical status I who were scheduled for elective minimal invasive partial diskectomy.
Interventions:
There was no intervention involved in this study.
Measurements:
Changes in differential counts, lymphocyte subsets, and proliferation rates were determined before surgery and in the early postoperative period. Plasma concentrations of proinflammatory cytokines (IL-2, IL-6, IL-12, interferon gamma) and anti-inflammatory cytokines (IL-10, IL-1RA, transforming growth factor beta), and plasma concentrations of cortisol, epinephrine, and norepinephrine were measured before, during, and after surgery.
Main Results:
Absolute number of CD3+, CD4+, and CD8+, and expression of HLA-DR and activation marker CD25+, CD26+, and CD69+ decreased more in response to surgery after BAL. Changes in distribution of T-lymphocyte cells seem to be in part related to severe postoperative pain. Plasma concentration of IL-6 significantly increased during and after surgery with BAL without relation to pain.
Conclusion:
Anesthetic management may have varying influences on the postoperative immune response. Surgery-induced inflammatory response and alteration in cell-mediated immunity seem to be more pronounced after BAL. These effects were attributed to the enhanced stress response after BAL.
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