GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil.
Department of Biostatistics, Institute of Biosciences, São Paulo State University - UNESP, Botucatu, Brazil.
Int Immunopharmacol. 2021 Jan;90:107163. doi: 10.1016/j.intimp.2020.107163. Epub 2020 Nov 16.
There is growing interest in assessing possible immunotoxicological effects in anesthetized patients. There are controversial findings concerning the effect of nitrous oxide (NO) anesthetic gas effect on inflammatory response. We tested the hypothesis that NO associated with desflurane (inhalational anesthetic) was likely to worsen neuro-immune-endocrine effects when compared with desflurane alone in this randomized trial. The primary endpoint of this study was to evaluate the systemic proinflammatory interleukin (IL)-6, and the secondary endpoints included other systemic (IL-1β, TNF-α, IL-8, IL-10, IL-17A and high-sensitivity C-reactive protein - hs-CRP) and genetic inflammatory markers (NF-kB, IL-6 and COX-2) as well as hormones (adrenocorticotropic hormone, cortisol and prolactin) comparing patients undergoing minor surgery with or without NO-desflurane. As a second aim, we assessed whether there were changes in the neuro-immune-endocrine profiles within each group. Blood samples were collected before anesthesia, 90 min after anesthesia induction, and the day after surgery. We assessed serum cytokines using a cytometric bead array and hs-CRP by chemiluminescent immunoassay. Expression of three proinflammatory transcripts was assessed by real-time quantitative polymerase chain reaction, and neuroendocrine hormones were detected by chemiluminescent microparticle immunoenzymatic assay. There were no significant between-group differences for any analyzed biomarkers. However, there was a significant increase in: (a) systemic IL-6 and hs-CRP values one day after surgery in both groups and (b) prolactin levels in the intraoperative period compared to baseline and postoperative period levels for both groups. In conclusion, NO does not impair the inflammatory profile and neuroendocrine response compared to patients who receive only desflurane anesthesia.
人们对评估麻醉患者潜在免疫毒性作用的兴趣日益浓厚。关于一氧化二氮（N2O）麻醉气体对炎症反应的影响，存在争议的发现。我们通过这项随机试验检验了一个假设，即在与单独使用地氟醚（吸入麻醉剂）相比，与地氟醚相关的一氧化二氮可能会加重神经免疫内分泌的影响。本研究的主要终点是评估全身促炎性白细胞介素（IL）-6，次要终点包括其他全身（IL-1β、TNF-α、IL-8、IL-10、IL-17A 和高敏 C 反应蛋白 - hs-CRP）和遗传炎症标志物（NF-kB、IL-6 和 COX-2）以及激素（促肾上腺皮质激素、皮质醇和催乳素），比较接受小手术的患者是否使用 N2O-地氟醚。作为第二个目的，我们评估了每组内神经免疫内分泌谱是否有变化。在麻醉前、麻醉诱导后 90 分钟和手术后一天采集血样。使用流式细胞术珠阵列评估血清细胞因子，用化学发光免疫分析法评估 hs-CRP。通过实时定量聚合酶链反应评估三种促炎转录物的表达，通过化学发光微粒子免疫酶分析检测神经内分泌激素。任何分析生物标志物在组间均无显著差异。然而，与基线和术后水平相比，在：（a）两组术后一天的全身 IL-6 和 hs-CRP 值均显著增加；（b）两组术中催乳素水平均显著增加。总之，与仅接受地氟醚麻醉的患者相比，NO 不会损害炎症谱和神经内分泌反应。
