Fentanyl and the interleukin‐6 response to surgery

Abstract

SummaryIt has been suggested that large doses of opioids may suppress the interleukin-6 response to surgery. We examined the effects of the supplementation of inhalational anaesthesia with either 3 or 15 mg.kg ¹1 fentanyl on the circulating interleukin-6, interleukin-8, C-reactive protein, cortisol and glucose concentrations in 16 patients undergoing pelvic surgery. In both groups, surgery evoked the expected glucose, cortisol and interleukin-6 response but no increase in interleukin-8 was detected. There were no significant differences between the two groups. We conclude that the supplementation of inhalational anaesthesia with conventional doses of opioids does not modify the cytokine response to surgery. Cytokines are important mediators of the physiological response to surgical trauma. Interleukin-6 is the major circulating cytokine found after routine surgery and stimulates the acute phase response [1]. Both the size and the duration of the increased interleukin-6 concentration are roughly proportional to the severity of the surgical trauma [2]. There is little information on the effects of anaesthesia on the cytokine changes associated with surgery. Crozier et al. found that interleukin-6 release in response to abdominal surgery was less with a total intravenous technique (propofol and alfentanil) than with an inhalational technique [3]. They postulated that the opioid was responsible for the attenuated response and indicated cellular mechanisms by which this may occur. Nevertheless, an effect of propofol cannot be excluded.The purpose of this study was to compare the effects of supplementing inhalational anaesthesia with either 3 or 15 mg.kg ¹1 fentanyl on the interleukin-6 response to pelvic surgery. We also measured interleukin-8 levels, as these are known to increase in various inflammatory states and with cardiopulmonary bypass [4,5] but the effects of routine surgery are unclear. MethodsWe studied 16 women undergoing total abdominal hysterectomy for nonmalignant disease. They were otherwise healthy and had no endocrine or metabolic disorders. The patients were allocated randomly to receive either 3 or 15 mg.kg ¹1 fentanyl intravenously at induction of anaesthesia. The study was approved by the local ethics committee and written, informed consent was obtained from all patients.Patients were given temazepam 20 mg orally for premedication 90 min before surgery. In the anaesthetic room, a central vein was catheterised via the antecubital fossa for the administration of intravenous fluids and the collection of blood samples. In all patients anaesthesia was induced with thiopentone in a dose sufficient to obtund the eyelash reflex and fentanyl 3 or 15 mg.kg ¹1 given intravenously according to the randomisation. Vecuronium 0.1 mg.kg ¹1 was administered to facilitate tracheal intubation and the patients' lungs were ventilated with isoflurane and 66% nitrous oxide in oxygen. Sodium chloride 0.9% solution was infused at a rate of 6 ml.kg ¹1 .h ¹1 during the operation and 2 ml.kg ¹1 .h ¹1 after surgery. Standar...

Effect of ulinastatin on cytokine reaction during gastrectomy

“…It has been suggested that large doses of opioids may suppress the cytokine response to surgery, but conventional doses of opioids do not [23]. Furthermore, the consumption of fentanyl in both groups was similar.…”

A randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia

“…15 However, it has been reported, again with abdominal hysterectomy, that IL-6 levels increased in a similar fashion after 3 or 15 lg/kg of fentanyl. 16 In patients undergoing pancreatoduodenectomy both IL-6 and TNF-a levels increased, an effect that was not influenced by supplemental epidural analgesia. 13 However, all these studies included only small numbers of patients and may therefore have been underpowered.…”

Bronchial cytokine level changes in lung cancer operations

“…In addition, we investigated the bronchial inflammatory process of the affected lung before and after surgery and the contralateral lung preoperatively. Numerous articles have been published regarding the effect of anesthesia type on cytokines, [11][12][13][14] but in our study, all of the patients received similar forms of anesthesia, and the operation times did not vary significantly.…”