[Cellular immune response to 3 anesthetic techniques for simple abdominal hysterectomy].
OBJECTIVE
The effect of surgery and anesthesia on the immune response may have a significant effect on perioperative tumor surveillance. The aim of this study was to characterize the cellular immune response of patients undergoing simple abdominal hysterectomy under 3 types of anesthesia.


METHODS
ASA 1-2 patients undergoing simple abdominal hysterectomy were enrolled prospectively after they gave informed consent; the patients were randomized to 3 groups of 20 each to receive balanced anesthesia (group A), remifentanil-based anesthesia and analgesia (group B), or combined general-epidural anesthesia (group C). Postoperative analgesia was provided in accordance with group assignment. Four and 24 hours after surgery, 20 mL of blood was drawn from each patient for analysis of leukocyte populations and lymphocyte subpopulations. Statistics were calculated with the SPSS software package, version 12.0.


RESULTS
All groups had elevated neutrophil counts after surgery; the lowest levels were in group C (P<.05). Patients in all 3 groups developed lymphopenia, which was still evident 24 hours after surgery (P<.05). CD3 cell counts at 4 hours were lowest in patients who had received combined anesthesia (group C), CD19 cell counts were highest in group A, and CD16 cell counts were lowest in group C; this last difference was maintained at 24 hours (P<.05 for all these comparisons).


CONCLUSIONS
Combined general-epidural anesthesia seems to lower the counts of natural killer cells that are involved in tumor surveillance and destruction.
Valién
J Longás
JL
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Clínico Universitario Lozano Blesa, Zaragoza. jalonva@terra.es
Hernando
A Navarro
AN
Gascón
A Hojas
AH
Francés
R Casans
RC
Lobera
J Cuartero
JC
D000230:Adenocarcinoma / Q000276:immunology / Q000601:surgery; D000698:Analgesia / Q000009:adverse effects / Q000379:methods; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D000700:Analgesics / Q000009:adverse effects / Q000494:pharmacology; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D018681:Anesthetics, General / Q000009:adverse effects* / Q000494:pharmacology; D016889:Endometrial Neoplasms / Q000276:immunology / Q000601:surgery; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D007157:Immunologic Surveillance / Q000187:drug effects; D007694:Killer Cells, Natural / Q000187:drug effects / Q000276:immunology; D016131:Lymphocyte Subsets / Q000187:drug effects / Q000276:immunology; D008231:Lymphopenia / Q000209:etiology* / Q000276:immunology; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D011183:Postoperative Complications / Q000209:etiology* / Q000276:immunology; D011446:Prospective Studies; D000077208:Remifentanil; D000077149:Sevoflurane
D000700:Analgesics; D018681:Anesthetics, General; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D009020:Morphine; D000077208:Remifentanil; D005283:Fentanyl