Elevated plasma levels of interleukin-6, interleukin-8, and granulocyte colony-stimulating factor during and after major abdominal surgery.
OBJECTIVE
To evaluate the influence of major abdominal surgery on the plasma levels of inflammatory cytokines interleukin-6 (IL-6), interleukin-8 (IL-8) and granulocyte colony-stimulating factor (G-CSF).


METHODS
Prospective study.


METHODS
University hospital.


METHODS
10 ASA physical status I and II patients undergoing upper abdominal surgery.


METHODS
All patients received combined general-epidural anesthesia with isoflurane and nitrous oxide, after insertion of an epidural catheter at T7-T9 dosed with 1.5% lidocaine.


RESULTS
Plasma cytokine (IL-6, IL-8, G-CSF) levels were determined with an enzyme-linked immunosorbent assay (ELISA) at pre-anesthesia, 0, 2, and 4 hours during surgery, and at the end of surgery, followed by sampling on the morning of postoperative days 1 (POD1) and 3 (POD3). Plasma cortisol levels were also determined. The plasma levels of IL-6 increased gradually after skin incision and reached the maximal value at the end of surgery (p < 0.001). IL-8 levels also increased from the baseline value to their maximum at the end of surgery (p < 0.05). G-CSF levels were elevated from the pre-anesthesia value to their maximum by the end of operation (p < 0.005). Plasma cortisol levels were increased after skin incision (p < 0.001). Postoperative cytokine levels correlated significantly with each other (r = 0.68, p < 0.05 for IL-6 vs. IL-8; r = 0.81, p < 0.005 for IL-6 vs. G-CSF; and r = 0.84, p < 0.005 for IL-8 vs. G-CSF). Postoperative IL-6 levels and intraoperative blood loss correlated significantly (r = 0.64, p < 0.05).


CONCLUSIONS
These results suggest that major upper abdominal surgery stimulates the release of inflammatory cytokines presumably from the operation site. Further study is warranted to evaluate the modulation of inflammatory responses in the perioperative period.
Kato
M
M
Department of Anesthesiology, Tohoku University School of Medicine, Sendai, Japan.
Suzuki
H
H
Murakami
M
M
Akama
M
M
Matsukawa
S
S
Hashimoto
Y
Y
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D018681:Anesthetics, General; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood*; D007432:Intraoperative Period; D007530:Isoflurane; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors
D018681:Anesthetics, General; D015850:Interleukin-6; D016209:Interleukin-8; D016179:Granulocyte Colony-Stimulating Factor; D007530:Isoflurane; D009609:Nitrous Oxide; D006854:Hydrocortisone