Effect of dexmedetomidine combined with lumbar anesthesia on Th1/Th2 in maternal patients and neonates undergoing caesarean section

Abstract

The selection of anesthetic method and drugs is of utmost importance for patients undergoing caesarean section. The application of anesthetic drugs may affect the immune system of the maternal patient and neonate. Therefore, the present study aimed to analyze the effect of dexmedetomidine combined with lumbar anesthesia on type 1 T-helper cells (Th1) and Th2 cytokines in mothers and their neonates undergoing caesarean section. A total of 60 females with full-term pregnancies and an American Society of Anesthesiologists grade I or II who received caesarean section were selected and equally divided in a randomized manner into a control group receiving lumbar epidural anesthesia and a combination group treated by dexmedetomidine combined with lumbar epidural anesthesia. The visual analogue scale (VAS) score, adverse reactions, traction response and the neonates' Apgar score were compared between the two groups. The levels of interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), IL-4 and IL-10 in the blood of mothers and neonates were detected by reverse transcription-quantitative PCR and ELISA. The results indicated no statistically significant difference in the Apgar score between the two groups. The VAS scores, adverse reactions, reduced traction response, as well as IL-2 and TNF-α expression, in the mothers of the combination group were significantly decreased, while IL-4 and IL-10 were obviously elevated compared with those in the controls (P<0.05). Furthermore, IL-2 and TNF-α levels were markedly declined, whereas IL-4 and IL-10 expression was apparently enhanced in the neonates from the combination group compared with those in the control group (P<0.05). In conclusion, dexmedetomidine in addition to lumbar epidural anesthesia reduces the VAS score, adverse reactions and traction response, and promotes the conversion of Th1 cytokines to Th2 cytokines in mothers/nonates after caesarean section.

Dexmedetomidine as an adjuvant for single spinal anesthesia in patients undergoing cesarean section: a system review and meta-analysis

“…Five trials were excluded because of epidural–spinal combined anesthesia. 13,14,20–22 Two articles were excluded because they were not RCTs, 23,24 two articles were excluded because of the type of surgery, 25,26 and one trial was excluded because the control was not placebo. 27 Finally, ten RCTs were included in our meta-analysis.…”

“…10–12 Previous studies confirmed that dexmedetomidine might play a role in improving the effectiveness of spinal anesthesia while administered as an adjunct. 13,14 A meta-analysis indicated that dexmedetomidine could shorten the spinal anesthesia onset time in cesarean section. 15 However, the inclusion criteria are flawed, and neonate safety was not assessed.…”

Factors of Intervertebral Disc Rehydration after Percutaneous Endoscopic Lumbar Discectomy

“…Yao 22 reported that the amount of Th1 in the nucleus pulposus tissue of rats with IDD increased signi cantly, reaching a peak on the 14th day after model development and decreasing on the 28th day. Other studies have shown that IL-4 secreted by Th2 can alleviate intervertebral disc in ammation by binding IL-4 receptor α of intervertebral disc cells; particularly, the expression level of this receptor is higher in the herniated intervertebral disc, suggesting the protective effect of Th2 on IDD 23 , 24 .…”

Effects of Dexmedetomidine on Immune Cells: A Narrative Review

“…Although cesarean section may affect the levels of IL-2 and IL-4, but it turns out that there is no significant difference compared with normal delivery. Therefore, DEX combined with intraspinal anesthesia can reduce the adverse reactions of puerpera after cesarean section, and promote the transformation of Th1 cytokines to Th2 cytokines ( Shi and Zhang, 2019 ). In the anesthesia of patients with colon cancer radical operation, the indexes of Th1 and Th1/Th2 in DEX group were lower than that in the control group, which promoted the transformation of Th1 cytokines to Th2 cytokines, and DEX can significantly inhibit the activation of NF-κB, soluble intercellular adhesion molecule-1 (sICAM-1), IL-8 and IL-6 caused by anesthesia ( Wang and Li, 2018 ).…”