Effect of 2 anesthetic techniques on the postoperative proinflammatory and anti-inflammatory cytokine response and cellular immune function to minor surgery.

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.