title: The effects of intraoperative esmolol administration on perioperative inflammatory responses in patients undergoing laparoscopic gastrectomy: a dose-response study.
abstract: BACKGROUND
  Surgical trauma elicits inflammatory responses, including the secretion of cytokines. Recent studies demonstrated that beta-blockers could reduce the expression of cytokines after injury. We therefore tested the effects of different doses of intraoperative esmolol on the inflammatory response after surgery.
  
  
  METHODS
  Patients undergoing laparoscopic gastrectomy were randomly separated into 1 of 3 groups: saline, clinical dose, and subclinical dose groups. The levels of interleukin (IL)-6, IL-4, and IL-10 were quantified by sandwich enzyme-linked immunoassay after the induction of anesthesia (T0), at the end of peritoneal closure (T1), and 60 minutes after surgery (T2). Levels of C-reactive protein (CRP) were measured on postoperative day 1.
  
  
  RESULTS
  At T2, the levels of IL-6 and IL-10 in the saline group were elevated significantly compared with at T0 or T1 (IL-6: 119.62 and 15.97 pg/mL at T2 and T0, respectively [P = .042]; IL-10: 27.27 and 7.03 pg/mL at T2 and T1, respectively [P = .037]). However, no changes were observed over time in the clinical dose group. In contrast, postoperative levels of IL-4 were decreased significantly in the clinical dose group compared with the saline group (2.14 vs 21.91 pg/mL, P = .022). In addition, the CRP levels on postoperative day 1 were lower in the esmolol-treated groups, in a dose-dependent manner.
  
  
  CONCLUSIONS
  Serum IL-6 and IL-10 levels were increased over time, suggesting that laparoscopic surgery is a stressor, even though it causes minimal tissue injury. Treatment with esmolol decreased the inflammatory response and CRP production in a dose-dependent manner.
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Yongsuk
authors.initials: Y
authors.lastname: Kim
authors.affiliation: The Catholic University of Korea, Seoul, Korea amoeba79@catholic.ac.kr.
authors.forename: Wonjung
authors.initials: W
authors.lastname: Hwang
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Mi-La
authors.initials: ML
authors.lastname: Cho
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Yang-Mi
authors.initials: YM
authors.lastname: Her
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Seulgi
authors.initials: S
authors.lastname: Ahn
authors.affiliation: The Catholic University of Korea, Seoul, Korea.
authors.forename: Jaemin
authors.initials: J
authors.lastname: Lee
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage*; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000188:drug therapy / Q000378:metabolism; D007378:Interleukins / Q000097:blood; D007430:Intraoperative Care; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D007378:Interleukins; D011412:Propanolamines; D002097:C-Reactive Protein; C036604:esmolol
keywords: beta-blocker; cytokine; esmolol; surgery