The effect of anaesthesia and surgery on plasma cytokine production.
The 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)-1beta, IL-2, IL-4, IL-6, tumour necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma) 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-1beta, IL-4, IL-6, TNF-alpha and IFN-gamma 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-1beta, IL-2, IL-4, IL-6 and TNF-alpha showed a significant increase in group 2 (p < 0.005 for IL-1beta, IL-2 and IL-4, and p < 0.05 for IL-6 and TNF-alpha); while in group 1, only IL-2 showed a significant increase (p < 0.01) and IFN-gamma showed a significant decrease (p < 0.05) compared with pre-incisional levels. By 24-h postoperatively, IL-1beta, IL-4, IL-6 and TNF-alpha 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-gamma 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-1beta, IL-4, IL-6, TNF-alpha and IFN-gamma 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-1beta, IL-6 and TNF-alpha) and the anti-inflammatory (IL-4) components, while this response was absent in laparoscopic cholecystectomy.
Helmy
S A
SA
Anaesthesia and ICU Department, Jahra Hospital, Egypt.
Wahby
M A
MA
El-Nawaway
M
M
D000328:Adult; D019162:Anesthetics, Combined / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001279:Atracurium / Q000494:pharmacology; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic; D016207:Cytokines / Q000096:biosynthesis* / Q000097:blood / Q000187:drug effects; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000096:biosynthesis; D007378:Interleukins / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D015742:Propofol / Q000494:pharmacology; D017409:Sufentanil / Q000494:pharmacology; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D016207:Cytokines; D007378:Interleukins; D003473:Neuromuscular Nondepolarizing Agents; D014409:Tumor Necrosis Factor-alpha; D001279:Atracurium; D007371:Interferon-gamma; D017409:Sufentanil; D015742:Propofol