A randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia.
BACKGROUND
Cytokines are significant mediators of the immune response to surgery and also play a role in parturition. The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha.


METHODS
Thirty-five parturients scheduled for elective cesarean section were randomly assigned to general (n=18) or neuraxial (n=17) anesthesia. The general anesthesia group received thiopental 4 mg/kg, succinylcholine 1-1.5 mg/kg and 1% end-tidal concentration of sevoflurane in nitrous oxide and 50% oxygen. The neuraxial anesthesia group received intrathecal 0.5% levobupivacaine 1.8-2.2 mL and epidural fentanyl 1 microg/kg. Blood samples were taken for IL-6 and TNF-alpha immediately after positioning the parturient on the operating table, after uterine incision and before the umbilical cord clamping and 24h after surgery (T(1), T(2) and T(3) respectively).


RESULTS
The two groups did not differ in IL-6 (P=0.15) or TNF-alpha (P=0.73) serum concentrations at any time point. In the general and neuraxial anesthesia groups, IL-6 serum concentrations were significantly higher in the third blood sample, T(3) (12.2+/-5.0 and 15.2+/-4.3 pg/mL), than in T(1) (0.41+/-0.38 and 0.29+/-0.10 pg/mL) and T(2) (0.37+/-0.47 and 0.24+/-0.05) respectively (P<0.001). Within each group, serum TNF-alpha concentrations did not differ significantly over time (P=0.44).


CONCLUSIONS
Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section. Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique.
Dermitzaki
E
E
Department of Anesthesia, Aretaieio Hospital, Medical School, University of Athens, Greece.
Staikou
C
C
Petropoulos
G
G
Rizos
D
D
Siafaka
I
I
Fassoulaki
A
A
D000328:Adult; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D002585:Cesarean Section; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011247:Pregnancy; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha