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[Comparison of the effects of isoflurane and alfentanyl on the mononuclear-phagocytic system]
J A Carrera1, J Catalá, P Monedero
1Departamento de Anestesiología y Reanimación, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra.
Background Aims:
The effects of two anesthetic agents, alfentanil and isoflurane, on the macrophage-monocytic system and the relation with the adrenocortical-hypophyseal axis were analyzed.
Material And Methods:
Thirty ASA I-II patients submitted to elective surgery were distributed into two groups: group I, analgesic anesthesia with alfentanil 100 micrograms/kg, a perfusion of 2-3 micrograms/kg/min and naloxone 0.2-0.4 mg upon termination of surgery; group II, inhalation anesthesia with isoflurane at 2-2.5% and O2/air = 1/1. HLA-DR membrane receptors and vimentin threads of the cytoskeleton were determined in basal conditions, at one hour and two hours of induction and upon termination of surgery by means of indirect immunofluorescence with the use of monoclonal antibodies. Phagocytosis of latex particles was also measured and ACTH and cortisol levels were obtained by radioimmunoassay.
Results:
In group I (alfentanil) a decrease (p < 0.01) of all the monocyte parameters analyzed, which was more significant than that observed in group II (isoflurane), was observed. In group II only the expression of HLA-DR and the index of phagocytosis (p < 0.05) were statistically significant. Following the administration of naloxone a reversion of these parameters was observed. The maximum immune depression corresponded with the lowest values of ACTH and cortisol (group I) with surgical stress being discarded as the cause of this immunodepression.
Conclusions:
Alfentanil produces a monocytic depression which reverses following the administration of naloxone, thus discarding surgical stress as the cause of this immunodepression suggesting a mechanism mediated by opiate receptors. With regards to isoflurane, the functions of the mononuclear-phagocytic system were hardly altered in the patient studied.
Insights
Alfentanil significantly depresses monocyte function, an effect reversed by naloxone, suggesting opiate receptor involvement. Isoflurane had minimal impact on the mononuclear-phagocytic system, indicating it is a safer anesthetic choice for immune function.
Area of Science:
- Immunology
- Anesthesiology
- Endocrinology
Background:
- Anesthetic agents can impact immune function and the neuroendocrine system.
- Understanding these effects is crucial for patient outcomes during surgery.
Purpose of the Study:
- To analyze the effects of alfentanil and isoflurane on the macrophage-monocytic system.
- To investigate the relationship between these anesthetic agents and the adrenocortical-hypophyseal axis.
Main Methods:
- Thirty patients were divided into two groups: alfentanil (analgesic) and isoflurane (inhalation anesthesia).
- Monocyte parameters (HLA-DR, vimentin, phagocytosis) and ACTH/cortisol levels were measured.
- Immunofluorescence and radioimmunoassay techniques were employed.
Main Results:
- Alfentanil significantly decreased all monocyte parameters (p < 0.01), more so than isoflurane.
- Isoflurane showed statistically significant effects only on HLA-DR expression and phagocytosis (p < 0.05).
- Naloxone administration reversed the effects of alfentanil, correlating with lower ACTH and cortisol levels, independent of surgical stress.
Conclusions:
- Alfentanil induces monocytic depression mediated by opiate receptors, reversible with naloxone.
- Surgical stress was ruled out as the cause of alfentanil-induced immunodepression.
- Isoflurane demonstrated minimal alteration of mononuclear-phagocytic system functions.