Hasselager Rune Petring, Madsen Signe Sloth, Møller Kirsten, Gögenur Ismail, Asghar Mohammad Sohail
Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark.
Department of Neuroanaesthesiology, Neuroscience Centre, Rigshospitalet, Copenhagen, Denmark.
BJA Open. 2022 Apr 13;2:100005. doi: 10.1016/j.bjao.2022.100005. eCollection 2022 Jun.
Sevoflurane and propofol are commonly used drugs in general anaesthesia. However, their effects on perioperative immune function are incompletely understood. We hypothesised that sevoflurane and propofol differentially affect immune function in healthy individuals. Therefore, we investigated the effect of sevoflurane and propofol on neutrophil-to-lymphocyte ratio before, during, and after general anaesthesia.
In this randomised crossover study, 19 healthy individuals underwent 2 h of general anaesthesia with either propofol or sevoflurane. After 4 weeks, anaesthesia was repeated using the other drug. Blood samples were obtained before, during, 1 h after, and 1 day after anaesthesia. The primary outcome was whole-blood neutrophil-to-lymphocyte ratio, and secondary outcomes were specific white blood cell differential counts. A linear mixed-effects model was used to estimate effect sizes.
The neutrophil-to-lymphocyte ratio was higher in the propofol compared with the sevoflurane group during anaesthesia, 2.8 (confidence interval [CI]: 2.3-3.3) 1.6 (CI: 1.1-2.1), and 1 day after anaesthesia, 2.6 (CI: 2.1-3.1) 1.9 (CI: 1.4-2.4). In all patients, we observed transient lymphopaenia during propofol anaesthesia, 1.1 × 10 cells × L (CI: 0.9-1.4), compared with sevoflurane anaesthesia, 1.9 × 10 cells × L (CI: 1.7-2.1). In addition, neutrophil counts were higher 1 day after propofol anaesthesia, 4.4 × 10 cells × L (CI: 4.0-4.9), compared with sevoflurane anaesthesia, 3.5 × 10 cells × L (CI: 3.1-4.0). We observed no differences in the remaining white blood cell subgroups.
In healthy individuals undergoing general anaesthesia without surgery, the neutrophil-to-lymphocyte ratio was affected by the type of hypnotic used. Transient lymphopaenia was observed in all participants during propofol anaesthesia.
七氟醚和丙泊酚是全身麻醉中常用的药物。然而，它们对围手术期免疫功能的影响尚未完全明确。我们推测七氟醚和丙泊酚对健康个体的免疫功能有不同影响。因此，我们研究了七氟醚和丙泊酚在全身麻醉前、麻醉期间及麻醉后对中性粒细胞与淋巴细胞比值的影响。
在这项随机交叉研究中，19名健康个体分别接受丙泊酚或七氟醚全身麻醉2小时。4周后，使用另一种药物重复麻醉。在麻醉前、麻醉期间、麻醉后1小时及麻醉后1天采集血样。主要观察指标是全血中性粒细胞与淋巴细胞比值，次要观察指标是特定白细胞分类计数。采用线性混合效应模型估计效应大小。
麻醉期间，丙泊酚组的中性粒细胞与淋巴细胞比值高于七氟醚组，分别为2.8（置信区间[CI]：2.3 - 3.3）对1.6（CI：1.1 - 2.1）；麻醉后1天，丙泊酚组为2.6（CI：2.1 - 3.1）对1.9（CI：1.4 - 2.4）。在所有患者中，我们观察到丙泊酚麻醉期间出现短暂淋巴细胞减少，为1.1×10⁹细胞/L（CI：0.9 - 1.4），而七氟醚麻醉期间为1.9×10⁹细胞/L（CI：1.7 - 2.1）。此外，丙泊酚麻醉后1天中性粒细胞计数更高，为4.4×10⁹细胞/L（CI：4.0 - 4.9），七氟醚麻醉后为3.5×10⁹细胞/L（CI：3.1 - 4.0）。我们观察到其余白细胞亚群无差异。
在未进行手术的接受全身麻醉的健康个体中，中性粒细胞与淋巴细胞比值受所用催眠药物类型的影响。在丙泊酚麻醉期间，所有参与者均出现短暂淋巴细胞减少。
