Effects of propofol on the inflammatory response during robot-assisted laparoscopic radical prostatectomy: a prospective randomized controlled study

Abstract

Robot-assisted laparoscopic radical prostatectomy (RALRP) is a minimally invasive procedure; however, some amount of surgical trauma that can trigger systemic inflammation remains. Moreover, pneumoperitoneum during RALRP induces ischemia–reperfusion injury (IRI). Propofol, an anesthetic, is known to have anti-inflammatory and antioxidant properties. In the present study, we compared the effects of propofol with those of desflurane on inflammation and IRI during RALRP via measurements of different biomarkers and evaluation of perioperative renal function. Fifty patients were randomized to receive either desflurane (n = 25) or propofol (n = 25) with remifentanil during RALRP. Serum levels of interleukin (IL)-6 (IL-6), tumor necrosis factor alpha, C-reactive protein, and nitric oxide were measured 10 min after anesthesia induction (T1), 100 min after carbon dioxide (CO 2 ) insufflation (T2), and 10 min after CO 2 deflation (T3). Perioperative urine outputs and the serum creatinine level at 24 h after surgery were also recorded. We found that IL-6 levels at T2 and T3 were higher than those at T1 in both groups, although the increases were significant attenuated only in the propofol group. The other parameters showed no differences among the three time points in both groups. The intraoperative urine output was significantly higher in the propofol group than in the desflurane group, while the creatinine level showed no significant changes in either group. Our findings suggest that propofol can not only attenuate the inflammatory response during and after pneumoperitoneum in patients undergoing RALRP but also prevent oliguria during pneumoperitoneum.

Perioperative management of a patient undergoing resection of interleukin-6 producing pheochromocytoma

“…We used propofol as an anesthetic agent. It has been reported that intraoperative serum IL-6 levels were lower in general anesthesia compared with desflurane [ 15 ]. Moreover, it suppressed the release of inflammatory cytokines by lipopolysaccharides [ 16 ]; hence, propofol was selected in this case.…”

Effects of remifentanil and propofol on distant organ lung injury in an ischemia–reperfusion model

“…It has been proposed that remifentanil can suppress the cellular immune response in sepsis and may be protective for lungs, which are one of the earliest affected organs [ 31 ]. Some researchers found that opioid analgesics may significantly reduce cytokine response, and propofol and remifentanil suppress TNF-α and IL-6 induction, thus affecting neutrophil migration and adhesion molecule expression [ 19 , 32 ] Recently, studies on the protective effects of remifentanil against intestinal, hepatic and myocardial I/R injury have been reported [ 33 , 34 ]. These studies show that remifentanil prevents I/R damage in the local target organ.…”

“…Due to its structural characteristics, it has free radical scavenging properties. As propofol is highly lipid-soluble, it particularly accumulates on lipophilic membranes, which are very sensitive to oxidative injury, and may increase or prevent the decrease in antioxidant capacity [ 16 , 17 , 18 , 19 ].…”

Inhalation of low-dose desflurane prevents the hemodynamic instability caused by target-controlled infusion of remifentanil and propofol during laparoscopic gynecological surgery: A randomized controlled trial

“…Fifthly, a cost analysis with the use of the three agents was not a part of the present study. Finally, more outcomes, including the incidence of intraoperative awareness and body movement, and mechanism parameters, such as alterations in the stress response (catecholamines, noradrenaline, adrenaline, adrenocorticotropic hormone and cortisol) or inflammation factors (interleukin-6, tumor necrosis factor-α, C-reactive protein and nitric oxide) (33,34) should be recorded to comprehensively assess the anesthetizing effects of lower-dose desflurane combined with PR. The present study suggested that combining low-dose desflurane with PR may represent an efficient anesthesia regimen to prevent the hemodynamic instability of total intravenous anesthesia for patients undergoing laparoscopic gynecological surgery.…”