title: Lymphocyte apoptosis after major abdominal surgery is not influenced by anesthetic technique: a comparative study of general anesthesia versus combined general and epidural analgesia.
abstract: OBJECTIVE
  To examine the influence of abdominal colectomy with combined general anesthesia and epidural analgesia versus general anesthesia on apoptosis of circulating lymphocytes.
  
  
  METHODS
  Prospective, randomized, clinical comparison study.
  
  
  METHODS
  Tertiary-care general hospital.
  
  
  METHODS
  40 ASA physical status I and II patients undergoing elective open colectomy for nonmetastatic colon carcinoma.
  
  
  METHODS
  Patients were randomly allocated to two groups to receiver either general anesthesia alone (Group G) or general anesthesia combined with epidural analgesia (Group C). Group C comprised 21 patients while 19 patients constituted Group G. All patients underwent median longitudinal laparotomy.
  
  
  METHODS
  Blood samples were collected preoperatively and 24 hours postoperatively for measurement of lymphocyte apoptosis, serum cortisol, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
  
  
  RESULTS
  There were no differences between the two groups in age, weight, or duration of surgery. No significant alterations in total lymphocyte counts, as well as in lymphocyte subpopulations (early apoptotic, late apoptotic, viable, and necrotic), were observed between the general and combined anesthesia groups. Cortisol, ESR, and CRP were significantly increased postoperatively in both groups. Group C presented with lower serum cortisol levels postoperatively than Group G (b = -5.38, CI95%: -8.72 to -2.05, P = 0.002).
  
  
  CONCLUSIONS
  Epidural block could not suppress postoperative lymphocyte apoptosis, increases in cortisol, CRP, or ESR compared with general anesthesia.
authors.affiliation: Laboratory of Surgical Research, 1st Department of Propaedeutic Surgery, Hippokrateio Hospital, University of Athens, 11527 Athens, Greece.
authors.forename: Artemisia
authors.initials: A
authors.lastname: Papadima
authors.forename: Maria
authors.initials: M
authors.lastname: Boutsikou
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Lagoudianakis
authors.forename: Agapi
authors.initials: A
authors.lastname: Kataki
authors.forename: Manoussos
authors.initials: M
authors.lastname: Konstadoulakis
authors.forename: Loukas
authors.initials: L
authors.lastname: Georgiou
authors.forename: Vaggelogiannis
authors.initials: V
authors.lastname: Katergiannakis
authors.forename: Andreas
authors.initials: A
authors.lastname: Manouras
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods*; D017209:Apoptosis / Q000187:drug effects*; D001799:Blood Sedimentation / Q000187:drug effects; D002097:C-Reactive Protein / Q000187:drug effects / Q000378:metabolism; D003082:Colectomy / Q000379:methods*; D003110:Colonic Neoplasms / Q000601:surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008214:Lymphocytes / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D002097:C-Reactive Protein; D006854:Hydrocortisone