Department of Immunology, Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, Romania;
Rom J Morphol Embryol. 2021 Oct-Dec;62(4):961-969. doi: 10.47162/RJME.62.4.08.
The specific mechanism of action of each anesthetic drug on the immune system is still incompletely known. It is important to know how the various anesthetics used in minimally invasive surgery (MIS) act on the inflammatory response because the choice of the anesthetic agent can influence the patient's immune system.
Evaluation of the effect of anesthetic drugs used for total intravenous anesthesia (Propofol and Midazolam) on the inflammatory response after minimally invasive gynecological surgery.
PATIENTS, MATERIALS AND METHODS: The inflammatory response in 20 female patients who underwent minimally invasive gynecological surgery under which intravenous anesthesia was performed. Depending on the combination of anesthetics used, we subdivided the study group into two groups, Group 1 consisting of the patients (n=10) who were given for total intravenous anesthesia, the combination with Midazolam+Fentanyl, and Group 2 (n=10) the patients who received the combination of Propofol+Fentanyl, respectively. Surgical interventional procedures included day surgery: diagnostic and operative hysteroscopy, endometrial ablation, surgical treatment of vulvar disorders. Serological profiling of patients was performed by dosing the serum concentration of nucleotide-binding domain (NOD) and leucine-rich repeat protein 3 (NLRP3) inflammasomes, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), IL-10 before and two hours after the surgical procedure.
In our study, we found that in both groups of patients (Midazolam+Fentanyl - Group 1, Propofol+Fentanyl - Group 2), NLRP3 and cytokines concentrations in the serum were higher after MIS than those before MIS.
It appears that both Midazolam and Fentanyl and Propofol and Fentanyl have an immunomodulatory action due to the anti-inflammatory effect of both anesthetics. Therefore, anesthesiologists must choose an anesthetic method that uses individualized anesthetic agents, depending on the patient's immune status and disease.
每种麻醉药物对免疫系统的确切作用机制仍不完全清楚。了解微创外科（MIS）中使用的各种麻醉剂如何作用于炎症反应非常重要，因为麻醉剂的选择会影响患者的免疫系统。
评估用于全静脉麻醉的麻醉药物（异丙酚和咪达唑仑）对微创妇科手术后炎症反应的影响。
患者、材料和方法：对 20 名接受微创妇科手术的女性患者的炎症反应进行评估，这些患者在手术中接受了静脉麻醉。根据使用的麻醉剂组合，我们将研究组分为两组：第 1 组（n=10）接受咪达唑仑+芬太尼的全静脉麻醉，第 2 组（n=10）接受异丙酚+芬太尼的全静脉麻醉。手术干预程序包括日间手术：诊断性和手术性宫腔镜检查、子宫内膜消融术、外阴疾病的手术治疗。通过测定核苷酸结合域（NOD）和富含亮氨酸重复蛋白 3（NLRP3）炎性小体、白细胞介素（IL）-6、肿瘤坏死因子-α（TNF-α）、IL-10 的血清浓度对患者进行血清分析。
在我们的研究中，我们发现两组患者（咪达唑仑+芬太尼-第 1 组，异丙酚+芬太尼-第 2 组）在 MIS 后，血清中的 NLRP3 和细胞因子浓度均高于 MIS 前。
似乎咪达唑仑和芬太尼以及异丙酚和芬太尼都具有免疫调节作用，因为两种麻醉剂都具有抗炎作用。因此，麻醉师必须根据患者的免疫状态和疾病选择使用个体化麻醉剂的麻醉方法。
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