Kasachenko V M, Briskin B S, Evstifeeva O V, Savchenko Z I
Eksp Klin Gastroenterol. 2004(3):58-61, 105.
Surgical stress resulting from the operative morbidity and narcosis aggravates the associated age-related and secondary immunodeficiency of gerontological patients at surgeries. Stress hormones have a strong depressing effect on the immunity by forming stress immunodeficiency. Not only high blood level determines the damaging effect of stress hormones but also the activity of stress-limiting mechanisms of the immune system protect it from the damaging effect of stress hormones. In this connection, the impact of operative morbidity and anesthetic aggression on the activity of stress-realizing and, in particular, stress-limiting mechanisms plays an important role because of the frequency of postoperative complications in gerontological patients namely. We observed patients operated on the abdominal cavity by urgent indications with a delay or based on a schedule under conditions of epidural anesthesia (45 patients), spinal anesthesia (43 patients) and general anesthesia (41 patients). The analysis of data obtained shows that different types of anesthesia have different effect on the plasmic cortisol level and activity of stress-realizing and stress-limiting systems. Thus, in case of epidural anesthesia of gerontological patients it was possible to observe the reduction of the high plasmic cortisol level and activation of stress-limiting reception of immunocompetent cells contributing to the preservation of the immune function. The increased plasmic cortisol level accompanied spinal anesthesia applied to such patients. However, it did not suppress the stress-limiting reception protecting the immunity against the damaging action of cortisol. In case of general anesthesia of gerontological patients it was possible to observe the increased blood cortisol level and decreased activity of protective stress-limiting receptors contributing to the formation of glucocorticoid immunosuppression.
