Surgically induced immunologic alterations in the child

Surgery is generally believed to be an immunodepressant. This assumption is based, in part, upon studies of compromised patients undergoing major operation. Similar studies in normal adults following elective procedures are contradictory and little information is available regarding the pediatric surgical patient. This paper presents a study of immune function in children undergoing elective operation. Fifty healthy preoperative children (mean age: 20 months) were randomly selected. Ninety-five percent underwent inguinal herniorrhaphy. Operative time averaged 45 minutes (range: 30 to 90 minutes). Anesthesia consisted of Halothane and Nitrous Oxide in all cases. Approximately 2.5 cc of heparinized blood and 0.5 cc of serum were obtained immediately prior to and 2 hours following operation. Half of the children underwent assays of neutrophil function including absolute count, random migration, chemotaxis, phagocytosis, and bacterial killing. Serum was examined for opsonization of Staphylococcus aureus using the chemiluminescence method. The remaining children underwent lymphocytic quantitation including absolute count, total T cells, total B cells, T-helper cells, T-suppressor cells, and T-helper/suppressor ratio. Absolute neutrophil count increased 2.4 times preoperative values (P less than 0.01). There were, however, no significant alterations in neutrophil functional capabilities. Similarly, there was no alteration in serum opsonic capacity. There was a significant decrease in absolute lymphocyte count (6560-4013, P less than 0.01) postoperatively, and T cells, T-helper, T-suppressor, and B cells were all significantly affected (P less than 0.01 to 0.02). There was no change in the T-helper/suppressor ratio.(ABSTRACT TRUNCATED AT 250 WORDS)