Anästhesie und perioperative Immunfunktion

Abstract

Innate and acquired immunity plays a pivotal role in the host defense response. Pain, stress, necrotic tissue and invading microorganisms are known modulators of the complex immune response of patients undergoing major surgery. Anaesthesia itself or perioperative interventions of the anaesthesiologist may substantially alter the immune function with potential impact on the postoperative course. For instance, transfusion of allogenic blood and administration of dopamine or metoclopramide may interfere with immunity. Stress and pain are associated with immune tolerance, increased susceptibility to infection and tumor spreading in animal models. Thus, anaesthesia may--through modulation of the neurohumoral stress response--indirectly affect immunity of the surgical patient. In particular epidural anaesthesia and/or administration of epidural or spinal opioids seem to attenuate the stress response with beneficial effects on cellular and humoral immunity. In addition, anaesthetics, such as etomidate, propofol, or thiopentone and opioid analgesics may directly affect function of immune competent cells. However, these actions may only be apparent with high or supraclinical concentrations and/or long-term exposure. Regarding the latter, evidence suggests that long-term sedation using thiopentone in neurosurgical patients is paralleled by infectious complications in a dose-dependent manner. At present, no data are available regarding the significance of the observed alterations associated with various anaesthetic procedures of the incidence of postoperative complications associated with impaired immunity, such as infection or metastatic spreading in oncological surgery.

Intravenous anesthetic propofol suppresses leukotriene production in murine dendritic cells

“…Surgery suppresses the immune system due to its inevitable tissue damageinduced inflammation and stress, whose modification with anesthesia could affect the post-operative immunosuppression (Slade et al, 1975;Hensler et al, 1997;Bauer et al, 1998;Ogawa et al, 2000). Propofol is unique in its anti-inflammatory properties that could potentially modulate the surgery-induced inflammation, leading to modification of immune suppression after surgery.…”

Influence of Vaccination and Surgery on HLA-DR Expression in Patients with Upper Aerodigestive Tract Cancer

“…The rationale for including nonsurgical patients was to have a comparable control group without surgical stimulus or exposure to anaesthesia, both of which are known to affect cell-mediated immune responses. 20,26,27 In the present study, vaccination enhanced 303 CD Spies, M Kip, A Lau et al Enhanced HLA-DR expression after vaccination HLA-DR expression in conservatively-treated patients with cancer of the upper aerodigestive tract, whereas this effect did not extend to patients undergoing surgery. In addition, T cell mediated lymphokine release was not affected by vaccination.…”

Endotoxin

“…B. CD14, TLR4) oder die intrazellulären Signaltransduktionskaskaden (wie Kinasen), die die toxinabhängige Zellantwort vermitteln,gelten als potentielle Angriffspunkte immunmodulatorischer Strategien zur supportiven Therapie der Sepsis [42,54]. Nach Aktivierung des Makrophagen kommt es zur Ausschüttung früher proinflammatorischer "Alarmzytokine",insbesondere von TNF-α und IL-1,die ihrerseits die Synthese weiterer, "distaler" Zytokine wie IL-6, IL-8 oder IL-10 mit vielfältigen, teils gegensinnigen Wirkungen initiieren [2].Zu den Wirkungen dieser Zytokine gehört, neben der Unterhaltung der Akutphaseantwort (z. B. durch IL-6), auch eine antiinflammatorische Wirkung (z.…”