Effects of Anesthesia Based on Large Versus Small Doses of Fentanyl on Natural Killer Cell Cytotoxicity in the Perioperative Period

Beilin, Benzion; Shavit, Yehuda; Hart, Jacob; Mordashov, Boris; Cohn, Sergiu; Notti, Ida; Bessler, Hanna

doi:10.1213/00000539-199603000-00011

Cited by 55 publications

(69 citation statements)

References 17 publications

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“…In animal studies, TNF-a and IL-1 have been shown to be protective in certain situations [34,35]. Recent anaesthetic reports suggest that there may be some benefit from infusing cytokines, such as interferon a and b, and IL-2, on NK cell activity [36,37].…”

Section: Discussionmentioning

confidence: 99%

The effect of anaesthesia and surgery on plasma cytokine production

1999

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SummaryThe aim of this study was to investigate cytokine production in response to anaesthesia [total intravenous anaesthesia (TIVA) with propofol, sufentanil and atracurium] and surgery (laparoscopic vs. open cholecystectomy). Forty adult patients, ASA I-II, undergoing elective laparoscopic (group 1) or open (group 2) cholecystectomy were studied. Venous blood samples for measurement of interleukin (IL)-1b, IL-2, IL-4, IL-6, tumour necrosis factor-a (TNF-a) and interferon-g (IFN-g) were taken before the induction of anaesthesia, pre-incisionaly, at the end of anaesthesia and surgery and 24-h postoperatively. Pre-incisionaly, in both groups, IL-1b, IL-4, IL-6, TNF-a and IFN-g did not show a significant change, whereas IL-2 showed a significant decrease (p < 0.005 in group 1 and p < 0.001 in group 2) compared with pre-induction levels. By the end of anaesthesia and surgery, IL-1b, IL-2, IL-4, IL-6 and TNF-a showed a significant increase in group 2 (p < 0.005 for IL-1b, IL-2 and IL-4, and p < 0.05 for IL-6 and TNF-a); while in group 1, only IL-2 showed a significant increase (p < 0.01) and IFN-g showed a significant decrease (p < 0.05) compared with pre-incisional levels. By 24-h postoperatively, IL-1b, IL-4, IL-6 and TNF-a had decreased significantly in group 2 (p < 0.005 for IL-4 and p < 0.05 for the others); whereas in group 1, IL-2 and IFN-g showed a significant increase (p < 0.005) compared with the end of anaesthesia and surgery level. In conclusion, TIVA with propofol, sufentanil and atracurium does not seem to have a significant effect on IL-1b, IL-4, IL-6, TNF-a and IFN-g release. IL-2 was the only cytokine to show a significant decrease due to the effect of anaesthesia alone in both groups. The cytokine response to open cholecystectomy stimulated both the pro-inflammatory (IL-1b, IL-6 and TNF-a) and the anti-inflammatory (IL-4) components, while this response was absent in laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

The effect of anaesthesia and surgery on plasma cytokine production

1999

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“…8 Opioid analgesics inhibit both cellular and humoral immune function in humans. 9,10 Furthermore, morphine is pro-angiogenic and promotes breast tumour growth in rodents. 11 Consistent with this theory, surgical studies in animals indicate that regional anesthesia and optimum postoperative analgesia independently reduce the metastatic burden in animals inoculated with breast adenocarcinoma cells.…”

Section: Résumémentioning

confidence: 99%

Thoracic paravertebral regional anesthesia improves analgesia after breast cancer surgery: a randomized controlled multicentre clinical trial

Buggy

Fleischmann

et al. 2014

Can J Anesth/J Can Anesth

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Background The contribution of regional anesthesia with thoracic paravertebral blockade to postoperative analgesia remains unclear. We compared the effect of a combination of paravertebral blockade and propofol general anesthesia (GA) with sevoflurane GA and opioid analgesia on postoperative pain and opioid use for patients undergoing breast cancer surgery. Methods Patients having breast cancer surgery were randomly assigned to paravertebral analgesia with propofol GA (PPA, n = 187) or sevoflurane GA with perioperative opioid analgesia (SOA, n = 199). The PPA and SOA groups were compared for opioid consumption and pain outcomes (on a 0-10 visual analogue scale [VAS]) at two hours postoperatively using superiority and inferiority statistics. We compared our results with previous publications in a meta-analysis. [0,12] mg, respectively, morphine equivalents; median difference -3; 99% CI: -4 to -2). Thus, non-inferiority was detected for all the above outcomes, and superiority tests for each outcome were highly significant in the expected directions (P \ 0.001). Meta-analysis, including the current study, estimated a reduction in worst pain of 2.3 points (95% CI: 1.8 to 2.8) on a 0-10 scale and a 72% reduction (95% CI: 42 to 87) in Conclusion Nos résultats ont été largement concordants avec des études antérieures beaucoup plus petites. Comparativement à l'AG au sévoflurane avec analgésie par opioïdes, l'association d'une analgésie paravertébrale et d'une AG au propofol a fourni des avantages cliniques précoces pour les femmes subissant une chirurgie pour cancer du sein. Cette analyse est une sous-étude d'un essai randomisé multicentrique à double insu sur la récidive cancéreuse (www.ClinicalTrials.gov: n8 NCT00418457).

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“…10,11 Thirdly, opioid analgesics such as morphine and fentanyl, which are given to control surgical pain, might inhibit both cellular and humoral immune function in humans. 10,12 Fourthly, pain per se enhances the tumourpromoting effects of surgery and suppresses cell-mediated immunity. 4 Fortunately, previous investigations have demonstrated that regional anaesthesia, including epidural anaesthesia and spinal block, can attenuate or prevent these adverse effects.…”

Section: Introductionmentioning

confidence: 99%