Effect of propofol and isoflurane anaesthesia on the immune response to surgery*

Abstract

SummaryThere are two major subpopulations of peripheral helper T lymphocytes: T helper 1 (Th1) and T helper 2 (Th2) cells. Surgical stress increases the number of Th2 cells, and decreases that of Th1 cells, resulting in a decrease in the Th1 ⁄ Th2 ratio, and, consequently, in suppressed cellmediated immunity. Since anaesthesia can suppress the stress response to surgery, it may inhibit the decrease in the Th1 ⁄ Th2 ratio. Using flow cytometry, we studied whether propofol anaesthesia (n = 9) or isoflurane anaesthesia (n = 9) had more effect on the decrease in the Th1 ⁄ Th2 ratio after surgery in patients undergoing craniotomy. The Th1 ⁄ Th2 ratio decreased significantly after isoflurane anaesthesia (p = 0.011), while it did not change after propofol anaesthesia. The ratio was significantly lower with isoflurane than propofol (p = 0.009). Propofol anaesthesia attenuated the surgical stress-induced adverse immune response better than isoflurane anaesthesia.

The Anti-Inflammatory and Immunosuppressive Properties of Inhaled Anaesthetics - Data from Experimental Studies and Clinical Implications

“…The Anti-Inflammatory and Immunosuppressive Properties of Inhaled Anaesthetics -Data from Experimental Studies and Clinical Implications remained unchanged after the use of propofol (47).…”

Impact of anesthesia for cancer surgery: Continuing Professional Development

“…Aucune réduction significative du rapport Th1/Th2 n'a été observée quand le propofol était utilisé pour l'entretien de l'anesthésie chez les patients subissant une craniotomie. 18 Il a été également montré que le propofol le supprime la production de PGE2 par les monocytes via un effet sur l'activité de la cyclo-oxygénase.…”

“…Human studies showed a significant reduction in Th1:Th2 ratio when isoflurane was compared with propofol. 18 In vitro experiments revealed DNA damage to human peripheral blood lymphocytes in a dose-dependent manner following exposure to halothane, isoflurane, sevoflurane, and desflurane. Volatile anesthetics are known to upregulate expression of hypoxia-inducible factors, which are important for maintaining normal cellular function in hypoxic conditions but which are also associated with tumorigenesis and poor cancer prognosis.…”

“…When using propofol for maintenance of anesthesia in craniotomy patients, no significant reduction in Th1:Th2 ratio was seen. 18 Propofol has also been shown to suppress monocytic PGE2 production via an effect on COX activity.…”

Effects of Anesthesia & Anesthetic techniques on Cellular Immunity

“…The ratio was significantly lower with isoflurane than propofol. Propofol anaesthesia attenuated the surgical stress-induced adverse immune response better than isoflurane anaesthesia [5].…”