Anesthesia drugs, immunity, and long-term outcome

Homburger, Jay; Meiler, Steffen E.

doi:10.1097/01.aco.0000236143.61593.14

Cited by 87 publications

(66 citation statements)

References 60 publications

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“…The severity and duration of surgical trauma, patients' age, and anesthetic methods may influence perioperative stress response. [4][5][6][7][8][9] Anesthesia maintains homeostasis, makes the operation painless, reduces excessive response to surgery, and modulates immune responses. [10] In addition, anesthetics influence cellular (the functions of immune competent cells) and humoral (inflammatory mediator gene expression and secretion) inflammatory responses.…”

mentioning

confidence: 99%

The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty

Eroglu

Kokulu

Koca

et al. 2016

Eklem Hastalik Cerrahisi

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mentioning

confidence: 99%

The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty

Eroglu

Kokulu

Koca

et al. 2016

Eklem Hastalik Cerrahisi

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“…Therefore, the neuroen docrine system and proinflammatory cytokines and antiinflammatory cytokines synergistically augment their suppressive effects in the perioperative immune system. Interleukin6 (IL6) is an important media tor of the acute phase response and a sensitive mark er of tissue damage (7). The surgicalstressinduced release of hormones such as catecholamines (nore pinephrine and epinephrine), adrenocorticotropic hormone (ACTH) and cortisol via the autonomic nervous system and the HPA mediates inhibitory effects on immune functions (8,9).…”

Section: Introductionmentioning

confidence: 99%

Impact of anesthesia method on cortisol and interleukin-6 concentration changes during and after laparoscopic colorectal surgery

Gasiūnaitė¹,

Šipylaitė²,

Kontrimavičiūtė³

et al. 2012

AML

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Background. The surgicalstressinduced release of hormones, such as ca techolamines (norepinephrine and epinephrine), adrenocorticotropic hor mone (ACTH), and cortisol, via the autonomic nervous system and the hypothalamicpituitaryadrenal axis (HPA) mediates inhibitory effects on immune functions. Pain management may influence the immune response in the postoperative period. The goal of the present study was to examine to what extent postoperative pain management modulates the surgeryinduced alterations of the immune response, specifically, interleukin6, cortisol and C reactive protein (CRP); to compare effects of two pain management tech niques, based on NSAID and continuouos epidural infusion of a local anaes thetic and morphine mixture.Materials and methods. Local Bioethics Committee's approval was re ceived, patients ASA I-III scheduled for laparoscopic colorectal surgery (LCS) were randomised to receive general anesthesia (GA, N = 27) or combined ge neral anesthesia with epidural analgesia (EA, N = 26). Anesthesia was induced with propofol, fentanyl and atracurium and maintained with sevoflurane. The EA group received the first dose of 3 mg epidural morphine with 0.25-0.125% bupivacaine mixture 20-30 min before surgery and continuous epidural infu sion of bupivacaine 0.25% and 5 mg of a morphine mixture for postopera tive analgesia. The GA group received intravenuous fentanyl and morphine during surgery, and NSAID for postoperative pain management. There were 5 cases when laparoscopy was converted to open surgery due to surgery find ings, these cases made the thirdconversion group (CG) with further mainte nance intended analgesia type. Pain was evaluated using the visual analogue scale (VAS) after anaesthesia and 24 hours later. Venous blood samples for cortisol and interleukin6 were taken preoperatively before induction of ana esthesia (baseline), after surgery and 24 hours after baseline. Venuous blood samples for CRP were checked after 1, 2, 3, 4, 6 days after surgery. Collected data were stored in the data base and were analysed using SPSS for Windows Version 19.0. The data were analysed using the MannWhitney U test and Stu dent's t test for comparison of 2 groups and ANOVA for comparison of more than two groups. The Bonferroni adjustment was used to detect pairwise dif ferences between the groups. The Chisquare test was used to determine dif ferences between categorical variables. Differences between the groups were considered statistically significant at p < 0.05. 245Impact of anesthesia method on cortisol and interleukin6 concentration changes during... Results and discussion.There were statistically significant differences be tween the groups in pain score after surgery (p < 0.001) and 24 hours later (p < 0.000) and in bowel motility after anaesthesia (p < 0.001). In EA group bowel motility was observed in 96.2% of patients after surgery and lasted more than 24 hours despite of infusion of local anesthetic mixture with morphine. In the GA group only in 55.6% of cases bowel motility was observed after...

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“…Inhalant anesthetics induce dose-dependent respiratory depression, lead to arterial pressure reduction and potential cardiac arrhythmias, and are known to influence the immune system as well. Volatile anesthetics appear to suppress the effectors' functions of both innate and adaptive immunity, assist tumor growth in animal models, and facilitate aggregation of certain neurodegenerative disease proteins (HOMBURGER and MEILER, 2006). It has been demonstrated that anesthetic agents given during any procedure may lead to immunosuppression (KELBEL and WEISS, 2001).…”

mentioning

confidence: 99%

The effect of repeated sevoflurane and nitrous oxide exposure on immunity in rabbits

Adam¹,

Marin²,

Popović³

et al. 2018

Vet. arhiv

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: The effect of repeated sevoflurane and nitrous oxide exposure on immunity in rabbits. Vet. arhiv 88, 37-48, 2018. ABSTrACTThe aim of this study was to investigate the effect of repeated/prolonged exposure to sevoflurane and nitrous oxide on the immune response in rabbits. Venous blood samples were obtained from twenty New Zealand rabbits, randomly allocated to four groups of five rabbits each. Group A rabbits served as controls, breathing 100% oxygen, group B rabbits inhaled a mixture of oxygen and nitrous oxide, group C inhaled a combination of oxygen and sevoflurane, and group D inhaled a combination of oxygen, nitrous oxide and sevoflurane. Flow cytometry was used to determine the proportions of CD45+ and CD21 + leukocytes subpopulations. Peripheral lymph nodes, lungs and spleen were sampled and subjected to histologic examination. the greatest changes in the proportion of CD21 + and CD45 + cell counts on day 0 and day 21 showed a 30% decrease. This study demonstrated that sevoflurane alone and in combination with nitrous oxide exerts a strong immunosuppressive effect, modifying the physiological values of the hematologic parameters, and inducing histopathological alterations in peripheral lymph node, lung and spleen tissues.

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Anesthesia drugs, immunity, and long-term outcome

Abstract: Long-term outcome after surgery is a new safety concern in perioperative care. We are faced with enormous challenges in healthcare and research. As providers, tailoring an anesthetic plan to patients' needs will become increasingly critical, and immunology should help in this pursuit.

Cited by 87 publications

References 60 publications

The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty

The effects of general and spinal anesthesia on systemic inflammatory response in patients undergoing total knee arthroplasty

Impact of anesthesia method on cortisol and interleukin-6 concentration changes during and after laparoscopic colorectal surgery

The effect of repeated sevoflurane and nitrous oxide exposure on immunity in rabbits

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