Novac Marius Bogdan, Boldeanu Lidia, Dijmărescu Anda Lorena, Boldeanu Mihail Virgil, Neamțu Simona Daniela, Radu Lucreţiu, Manolea Maria Magdalena, Șerbănescu Mircea-Sebastian, Stoica Maria, Rotaru Luciana Teodora, Văduva Constantin-Cristian
Department of Anesthesiology and Intensive Care, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.
Diagnostics (Basel). 2024 Apr 24;14(9):880. doi: 10.3390/diagnostics14090880.
A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients' general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation.
剖宫产手术应激可能导致免疫系统减弱以及更多炎症细胞因子释放。这种反应，除了对儿茶酚胺的反应改变外，还可能显著影响母亲的免疫系统和患者术后的总体病程。这项前瞻性研究比较了在脊髓麻醉和全身麻醉下进行剖宫产的健康孕妇血浆中儿茶酚胺和细胞因子的水平。共有30名接受择期剖宫产的孕妇被分为两组：15名接受全身麻醉（GA），15名接受脊髓麻醉（SA）。在麻醉诱导前（术前）、术后6小时（术后6小时）和12小时（术后12小时）从所有受试者采集血样，以测量肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、IL-8、IL-4、IL-10、去甲肾上腺素（NE）和肾上腺素（EPI）的水平。当我们比较两组时，发现只有IL-6和IL-4在术前水平显著更高，而所有研究的细胞因子在术后6小时和12小时在GA组比SA组均呈现升高。在儿茶酚胺方面，我们发现血清水平与促炎或抗炎细胞因子呈正相关，这取决于一天中的时间和麻醉药物的类型。与SA相比，GA对炎症反应和儿茶酚胺水平有更一致的影响。本研究结果证实，麻醉类型可通过细胞因子和儿茶酚胺产生的变化在不同程度上改变术后免疫调节。SA可能是剖宫产的首选麻醉方法，因为它是一种能减轻围手术期应激且允许较少使用阿片类药物的麻醉方法，通过适当的免疫调节影响细胞因子的产生。
