The In Vivo Effects of General and Epidural Anesthesia on Human Immune Function

Procopio, Marcia A.; Rassias, Athos J.; DeLeo, Joyce A.; Pahl, Janice; Hildebrandt, Laurie; Yeager, Mark P.

doi:10.1213/00000539-200108000-00044

Cited by 39 publications

(22 citation statements)

References 22 publications

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“…Although NUC rates were low for the three study groups combined (4.6%), there was a statistically significant increase in NUC rates as operative time increased, with odds ratios of 1.9 and 4.8 for groups II and III vs group I. Anaesthetic agents are known to have an effect on the immune system [5]. This might affect infectious complications and, theoretically at least, increase the likelihood of tumour spread [6]. Thus, increased anaesthesia time could result in an increased immunological suppression, leading to an increase in some complications seen in the present study.…”

Section: Discussionmentioning

confidence: 98%

How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

et al. 2008

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OBJECTIVETo examine the association between the duration of anaesthesia and non‐urological complication (NUC) rates after surgery, as the increasing complexity of minimally invasive and laparoscopic procedures in urology has resulted in longer surgery and anaesthesia, and information on the effect of this on NUC rates is limited.PATIENTS AND METHODSWe identified 2196 patients who had open radical nephrectomy or nephron‐sparing surgery at our institution between 1989 and 2002. Patients were subdivided into groups I, II, and III according to the duration of general anaesthesia (<4, 4–6 and ≥6 h, respectively). NUCs after surgery, and mortality during and after surgery, were evaluated.RESULTSThere were 1340, 723, and 133 patients in groups I, II and III, respectively. The incidences of any NUC were 3.1%, 5.8% and 13.5%, respectively. The odds ratios for the likelihood of a NUC were 1.91 (P = 0.004) and 4.84 (P < 0.001) for groups II and III, respectively. These differences remained significant even after adjusting for patient and tumour characteristics. Perioperative mortality was highest in group III, at 2.3%, vs 0.4% in groups I and II.CONCLUSIONSLonger anaesthesia is associated with an increase in the incidence of perioperative complications and mortality, especially when the duration of anaesthesia is >6 h. This increase appears to be independent of patient’s preoperative health status, tumour extent and blood loss.

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Section: Discussionmentioning

confidence: 98%

How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

et al. 2008

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“…5 In contrast, propofol is variously reported to be inhibitory, 6 have little effect, 7 or even enhance immune function. 8 Opioid analgesics inhibit both cellular and humoral immune function in humans.…”

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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Section: Does the Type Of Anesthesia Influence The Risk Of Cancer Recmentioning

confidence: 99%

“…Regional anesthesia is believed to be beneficial against cancer recurrence due to reduced exposure to immunosuppressive agents (i.e., nitrous oxide), reduced surgical stress and adrenergic stimulation, but the mechanism is still unclear [147]. In fact, in absence of surgical stress, both general and local anesthesia have minor and transient effects on immune function [151].On the other hand, cancer proliferation involves several stimuli and mediators, which can be all affected by the anesthetics [147,152].NK cells activity was investigated in patients undergoing laparotomy colectomy under either general anesthesia or epidural anesthesia alone [145]. Patients receiving general anesthesia had a significant reduction of NK cells activity (36% vs. 22%, p=0.02) respect to preoperative values, whereas the epidural group did not shown significant changes.…”

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confidence: 99%

Anesthesia, cytokines and cancer recurrence

Kitamura¹,

Biaso²,

Ingelmo

et al. 2015

Glob Anesth Perioper Med

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Cytokines are essential mediators for the regulation of both innate and acquired immunity and hematopoiesis. They modulate immune cell signaling, activation, adhesion and functioning. They regulate the individual response to several insults such as infection, inflammation, trauma, and pain. Moreover, the balance between pro-inflammatory and anti-inflammatory cytokines is critical for the evolution of surgical complications and tumor progression.Several drugs, including anesthetic agents, influence cytokines secretion. Opioids, inhalational agents, intravenous and local anesthetics have shown different effects on immune system and cytokine expression. Therefore, anesthesia may play an important role in postoperative recovery and outcome of cancer patients.The aim of the present article is to review the main role of some important cytokines and the effect of anesthesia techniques and drugs on their secretion. Furthermore, current clinical evidence regarding the effects of anesthesia on cancer recurrence will be discussed. Cytokines and immune systemCytokines are proteins expressed in both innate and acquired immune system and are often named according to the secreting cells (i.e., lymphocytes, interleukins, etc.). They are essential mediators of the natural (non-specific, innate) immunity, which is the initial step of the inflammatory response. They also play a pivotal role during the specific immunity, which occurs after exposure to antigens, as they regulate lymphocyte and leukocyte activation, growth and differentiation, and the immune-mediated inflammation [1].The cytokines have different structures, but also common aspects, which are summarized in Table 1.The aim of the present article is to review the main role of some important cytokines and the effect of anesthesia techniques and drugs on their secretion. Cytokines receptorsThe cytokines receptors are formed by one or more transmembrane proteins: the extracellular portion binds the cytokine, whereas the cytoplasmic part starts the signal cascade. Based on the extracellular portion, they are divided in five categories. 1) Type I receptors, which have four α-helical stands and contain four cysteine residues and the amino acid motif tryptophanserine-X-tryptophan-serine (WSXWS).2) Type II receptors, structurally similar to Type I receptors, but without the sequence WSXWS. Cytokines functionProvided that the same cytokine may be produced during both innate and acquired immunity response, cytokines can be classified according to their functions: 1)Cytokines regulating the innate immunity and secreted by stimulated macrophages; 2)Cytokines regulating the acquired immunity and secreted by lymphocytes; 3)Cytokines stimulating the hematopoiesiss and secreted by bone marrow, leucocytes and other cells. Common aspects of CytokineTheir secretion is brief and limited in time Cytokine expressed during the innate immunity response Tumor necrosis factor (TNF-α, TNF-β)The TNF is responsible for the initial phase of acute inflammatory response, especially against ...

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The In Vivo Effects of General and Epidural Anesthesia on Human Immune Function

Cited by 39 publications

References 22 publications

How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

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

Anesthesia, cytokines and cancer recurrence

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