Anaesthetics and immune function

Kelbel, I.; Weiß, Manfred

doi:10.1097/00001503-200112000-00015

Cited by 94 publications

(75 citation statements)

References 59 publications

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“…Propofol is also known to alter the functions of immunocompetent cells, such as neutrophils, monocytes, and macrophages (10,11,36). Propofol decreases proinflammatory cytokine production and inducible nitric oxide synthase expression in LPS-stimulated mouse macrophage Raw 264.7 cells (10,11) and increases bacterial accumulation in lung and liver after venous infusion compared with the effects of saline infusion (26). Propofol binds to the ␤ 2 -subunit of the GABA A receptor (4,16), which regulates Cl Ϫ channels (32).…”

mentioning

confidence: 99%

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABA_A receptor and dysregulation of p130cas phosphorylation

Shiratsuchi

Kouatli

et al. 2009

American Journal of Physiology-Cell Physiology

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Surgical stress and anesthesia result in systemic immunosuppression. Propofol, a commonly used anesthetic agent, alters immune cell functions. Previously, we demonstrated that extracellular pressure increases macrophage phagocytosis. We hypothesized that propofol might influence pressure-induced macrophage phagocytosis in monocytes from patients undergoing surgery. Pressure (20 mmHg above ambient pressure) augmented phagocytosis in monocytes from non-propofol-anesthetized patients but reduced phagocytosis in monocytes from propofol-anesthetized patients. In vitro, propofol stimulated phagocytosis but reversed pressure-induced phagocytosis in THP-1 macrophages and monocytes from healthy volunteers. The GABAA receptor antagonists picrotoxin and SR-95531 did not affect basal THP-1 phagocytosis or prevent pressure-stimulated phagocytosis. However, picrotoxin and SR-95531 negated the inhibitory effect of pressure in propofol-treated cells without altering propofol-induced phagocytosis. Phosphorylation of the adaptor protein p130cas was inversely related to phagocytosis: it was inhibited by pressure or propofol but increased by pressure + propofol compared with propofol alone. Reduction of p130cas by small interfering RNA in THP-1 macrophages increased basal phagocytosis and prevented pressure and propofol effects. In conclusion, propofol may alter macrophage responses to pressure via the GABAA receptor and p130cas, whereas pressure also acts via p130cas but independently of GABAA receptors. p130cas may be an important target for modulation of macrophage function in anesthetized patients.

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mentioning

confidence: 99%

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABA_A receptor and dysregulation of p130cas phosphorylation

Shiratsuchi

Kouatli

et al. 2009

American Journal of Physiology-Cell Physiology

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“…33 These hormones cause specific metabolic alterations (the best known is an increase of muscle catabolism, with net negative nitrogen balance), but also affect humoral and cellular immune responses. 15 The transient immunosuppression induced by the surgical stress might be partially explained by a supranormal activation of the ACTHcortisol axis. It is important to underline that in such clinical conditions both hormones simultaneously increase, because of the loss of the normal pituitaryadrenocortical feed-back mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown previously that the magnitude of such stress response is proportional to the magnitude of injury, [1][2][3][4] to the total operating time 5,6 as well as to the amount of intraoperative blood loss 7,8 and to the degree of postoperative pain; 9,10 furthermore, it has been shown that the choice of anesthetic technique may modulate the extent of such response. [11][12][13][14][15] Decreasing the stress response to surgery and trauma is of high relevance to the anesthesiologist, since it may allow complex operations in high risk patients [American Society of Anesthesiologist (ASA) III-IV, malnourished, immunocompromised and/or elderly)]; [16][17][18] it has been suggested that decreasing operative stress may be a key factor in improving outcome and lowering the length of hospital stay as well as the total costs of patients care. 6,19,20 Thus, an important goal of current research on new anesthetics is to find the ideal "stress free" anesthetic, to limit the activation of the neuroendocrine, inflammatory and immune responses.…”

Section: Me Et Th Ho Od D:mentioning

confidence: 99%

“…21 Clinical evidence is accumulating that the choice of the main anesthetic is able to influence the stress response, by stimulating, inhibiting or modulating the pathophysiologic pathways which induce neurohormonal and immunologic alterations. 22,15 The effect of isoflurane or sevoflurane anesthesia on the modulation of neurohormonal response to surgical trauma remains unclear. Thus, the aim of the present study was to compare the effect of isoflurane or sevoflurane anesthesia on the release of stress hormones, in a selected group of patients undergoing laparoscopic pelvic surgery.…”

Section: Me Et Th Ho Od D:mentioning

confidence: 99%

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Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery

Marana

Annetta

Meo

et al. 2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Stress response to surgery is modulated by several factors, including magnitude of the injury, type of procedure (e.g., laparoscopy vs laparotomy) and type of anesthesia. Our purpose was to compare intra-and postoperative hormonal changes during isoflurane vs sevoflurane anesthesia, in a clinical model of well defined operative stress (laparoscopic pelvic surgery). M Me et th ho od d: :In this prospective randomized clinical study, 20 women requiring laparoscopic pelvic surgery for benign ovarian cysts received either a standard isoflurane plus fentanyl (Group A) or sevoflurane plus fentanyl anesthesia (Group B). Blood samples were collected preoperatively, 30 min after the beginning of surgery, at the end of surgery after extubation, and two and four hours after the end of surgery. Intra-and postoperative plasma levels of norepinephrine, epinephrine, adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH) and prolactin (PRL) were measured. R Re es su ul lt ts s: : Catecholamine levels and postoperative pain were similar in both groups. Nonetheless, in comparison to Group A, Group B showed a significant decrease of ACTH, cortisol and GH levels (A vs B at the end of surgery: ACTH 160 ± 45 vs 100 ± 40 pg·mL -1 ; cortisol 45 ± 8 vs 23 ± 7 µg·dL -1 ; GH 3 ± 2 vs 0.8 ± 0.4 ng·mL -1 ; P < 0.001 for all), but enhanced PRL levels (A vs B, at 30 min after the beginning of surgery: 139 ± 54 vs 185 ± 22 ng·mL -1 ; at the end of surgery: 100 ± 27 vs 141 ± 45 ng·mL -1 ; P < 0.001 for both).C Co on nc cl lu us si io on ns s: : In the clinical setting of low stress laparoscopic surgery, the type of volatile anesthetic significantly affected the stress response; the changes associated with sevoflurane suggested a more favourable metabolic and immune response compared to isoflurane. Objectif Méthode : L'étude clinique, prospective et randomisée, a été faite auprès de 20 femmes devant subir une intervention par laparoscopie pelvienne pour des kystes bénins de l'ovaire. Les patientes ont reçu, soit une anesthésie normale à l'isoflurane avec du fentanyl (groupe A), soit au sévoflurane avec du fentanyl (groupe B). Le sang a été prélevé avant l'opération, 30 min après le début, à la fin après l'extubation et, deux et quatre heures après l'opération. Les niveaux plasmatiques peropératoire et postopératoire de noradrénaline, d'adrénaline, d'hormone adrénocorticotrope (ACTH), de cortisol, d'hormone de croissance (GH) et de prolactine (PRL) ont été mesurés.Résultats : Les niveaux de catécholamine et la douleur postopéra-toire ont été similaires dans les deux groupes. Néanmoins, comparé au groupe A, le groupe B a affiché une baisse significative d' ACTH, GH 3 ± 2 vs 0,8 ± 0,

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“…Interleukin6 (IL6) is an important media tor of the acute phase response and a sensitive mark er of tissue damage (7). The surgicalstressinduced release of hormones such as catecholamines (nore pinephrine and epinephrine), adrenocorticotropic hormone (ACTH) and cortisol via the autonomic nervous system and the HPA mediates inhibitory effects on immune functions (8,9). The antiinflam matory effects of anesthetics may be beneficial in situations involving ischemia and reperfusion injury or the systemic inflammatory response sindrome (10).…”

Section: Introductionmentioning

confidence: 99%

Impact of anesthesia method on cortisol and interleukin-6 concentration changes during and after laparoscopic colorectal surgery

Gasiūnaitė¹,

Šipylaitė²,

Kontrimavičiūtė³

et al. 2012

AML

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Background. The surgicalstressinduced release of hormones, such as ca techolamines (norepinephrine and epinephrine), adrenocorticotropic hor mone (ACTH), and cortisol, via the autonomic nervous system and the hypothalamicpituitaryadrenal axis (HPA) mediates inhibitory effects on immune functions. Pain management may influence the immune response in the postoperative period. The goal of the present study was to examine to what extent postoperative pain management modulates the surgeryinduced alterations of the immune response, specifically, interleukin6, cortisol and C reactive protein (CRP); to compare effects of two pain management tech niques, based on NSAID and continuouos epidural infusion of a local anaes thetic and morphine mixture.Materials and methods. Local Bioethics Committee's approval was re ceived, patients ASA I-III scheduled for laparoscopic colorectal surgery (LCS) were randomised to receive general anesthesia (GA, N = 27) or combined ge neral anesthesia with epidural analgesia (EA, N = 26). Anesthesia was induced with propofol, fentanyl and atracurium and maintained with sevoflurane. The EA group received the first dose of 3 mg epidural morphine with 0.25-0.125% bupivacaine mixture 20-30 min before surgery and continuous epidural infu sion of bupivacaine 0.25% and 5 mg of a morphine mixture for postopera tive analgesia. The GA group received intravenuous fentanyl and morphine during surgery, and NSAID for postoperative pain management. There were 5 cases when laparoscopy was converted to open surgery due to surgery find ings, these cases made the thirdconversion group (CG) with further mainte nance intended analgesia type. Pain was evaluated using the visual analogue scale (VAS) after anaesthesia and 24 hours later. Venous blood samples for cortisol and interleukin6 were taken preoperatively before induction of ana esthesia (baseline), after surgery and 24 hours after baseline. Venuous blood samples for CRP were checked after 1, 2, 3, 4, 6 days after surgery. Collected data were stored in the data base and were analysed using SPSS for Windows Version 19.0. The data were analysed using the MannWhitney U test and Stu dent's t test for comparison of 2 groups and ANOVA for comparison of more than two groups. The Bonferroni adjustment was used to detect pairwise dif ferences between the groups. The Chisquare test was used to determine dif ferences between categorical variables. Differences between the groups were considered statistically significant at p < 0.05. 245Impact of anesthesia method on cortisol and interleukin6 concentration changes during... Results and discussion.There were statistically significant differences be tween the groups in pain score after surgery (p < 0.001) and 24 hours later (p < 0.000) and in bowel motility after anaesthesia (p < 0.001). In EA group bowel motility was observed in 96.2% of patients after surgery and lasted more than 24 hours despite of infusion of local anesthetic mixture with morphine. In the GA group only in 55.6% of cases bowel motility was observed after...

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Anaesthetics and immune function

Cited by 94 publications

References 59 publications

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABA_A receptor and dysregulation of p130cas phosphorylation

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABA_A receptor and dysregulation of p130cas phosphorylation

Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery

Impact of anesthesia method on cortisol and interleukin-6 concentration changes during and after laparoscopic colorectal surgery

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Anaesthetics and immune function

Cited by 94 publications

References 59 publications

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABAA receptor and dysregulation of p130cas phosphorylation

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABAA receptor and dysregulation of p130cas phosphorylation

Sevoflurane improves the neuroendocrine stress response during laparoscopic pelvic surgery

Impact of anesthesia method on cortisol and interleukin-6 concentration changes during and after laparoscopic colorectal surgery

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Product

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Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABA_A receptor and dysregulation of p130cas phosphorylation

Propofol inhibits pressure-stimulated macrophage phagocytosis via the GABA_A receptor and dysregulation of p130cas phosphorylation