title: Immunomodulatory effects of total intravenous and balanced inhalation anesthesia in patients with bladder cancer undergoing elective radical cystectomy: preliminary results.
abstract: BACKGROUND
  Although surgery and anesthesia induce immunesuppression, remains largely unknown whether various anesthetic techniques have different immunosuppressive effects on cancer patients. Therefore, the aim of this study was to investigate the influence of total intravenous anesthesia with target-controlled infusion (TIVA-TCI) and balanced inhalation anesthesia (BAL) on the peri-operative levels of inflammatory cytokines and regulatory T cells (Tregs) in patients with bladder cancer undergoing surgery.
  
  
  METHODS
  Twenty eight consecutive patients with bladder cancer who underwent radical cystectomy were prospectively randomized into two groups to receive TIVA-TCI (n = 14) or BAL (n = 14). Before the induction of anesthesia (T0), 6-8 hours (T1) post-surgery, and 5 days post-surgery (T2), Tregs and serum levels of interleukin -1beta (IL-1β), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), interleukin -2 (IL-2), interleukin -6 (IL-6), and interleukin -10 (IL-10) were measured.
  
  
  RESULTS
  In the peri-operative period all cancer patients showed a marked and significant increase in IL-6. Moreover, TIVA-TCI patients also showed a higher increase in IFN-γ, whereas in BAL patients Tregs were reduced by approximately 30% during surgery. The incidence of infections, metastases, and death was similar in both groups.
  
  
  CONCLUSIONS
  The increase in the Th1 response in the TIVA-TCI group and the reduction in Tregs in the BAL group seem to balance the immunosuppressive effect induced by IL-6. Therefore TIVA-TCI and BAL can be both used in major surgery in patients with bladder cancer without worsening the outcome.
authors: Department of Anesthesiology, Regina Elena, Rome National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
authors: Maria
authors: M
authors: Sofra
authors: Paola Cordiali
authors: PC
authors: Fei
authors: Luana
authors: L
authors: Fabrizi
authors: Maria Elena
authors: ME
authors: Marcelli
authors: Claudia
authors: C
authors: Claroni
authors: Michele
authors: M
authors: Gallucci
authors: Fabrizio
authors: F
authors: Ensoli
authors: Ester
authors: E
authors: Forastiere
mesh_terms: D000769:Anesthesia, Inhalation / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000276:immunology*; D015653:Cystectomy / Q000379:methods; D016207:Cytokines / Q000097:blood / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000276:immunology* / Q000601:surgery*
chemical_list: D018685:Anesthetics, Inhalation; D016207:Cytokines
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