Complement Activation and Interleukin Response in Major Abdominal Surgery

Abstract

The objective of this study was to evaluate whether major abdominal surgery leads to complement activation and interleukin response and whether the kind of anaesthesia influence complement activation and the release of inflammatory interleukins. The study design was prospective and randomised. Fifty patients undergoing open major colorectal surgery due to cancer disease or inflammatory bowel disease were studied. Twenty‐five patients were given total intravenous anaesthesia (TIVA) with propofol and remifentanil, and 25 patients were given inhalational anaesthesia with sevoflurane and fentanyl. To determine complement activation (C3a and SC5b‐9) and the release of pro‐ and anti‐inflammatory interleukins (tumour necrosis factor‐a (TNF‐a)), interleukin‐1b (IL‐1b), IL‐6, IL‐8, IL‐4 and IL‐10), blood samples were drawn preoperatively, 60 minutes after start of surgery, 30 minutes after end of surgery and 24 hours postoperatively. Complement was activated and pro‐inflammatory interleukins (IL‐6 and IL‐8) and anti‐inflammatory interleukins (IL‐10) were released during major colorectal surgery. There was no significant difference between TIVA and inhalational anaesthesia regarding complement activation and cytokine release. Major colorectal surgery leads to activation of the complement cascade and the release of both pro‐inflammatory and anti‐inflammatory cytokines. There are no significant differences between total intravenous anaesthesia (TIVA) with propofol and remifentanil and inhalational anaesthesia with sevoflurane and fentanyl regarding complement activation and the release of pro‐ and anti‐inflammatory interleukins.

Surgical Stress Response After Colorectal Resection

“…IL-10 inhibits the synthesis of proinflammatory cytokines and shifts the immune response from Th1 type to Th2 type. 25 In colorectal cancer, elevated serum levels of this cytokine have been reported to be a negative prognostic factor for disease-free and overall survival, and responsiveness to treatment. 26 One study indicated that the tumor necrosis factor-a/IL-10 quote predicted the occurrence of postoperative complications.…”

Assessing complement blockade in patients with paroxysmal nocturnal hemoglobinuria receiving eculizumab

“…23 Moreover, half-life was very heterogeneous in our patients, without any clear explanation as to why this should occur, because none of our patients presented kidney failure or any physical conditions that may explain such findings. We therefore feel that careful monitoring of C5 blockade using both a CH50 assay and assessing the eculizumab trough level may be helpful in evaluating possible underdosing, especially in specific situations including infections, 24,25 pregnancy or postpartum events, 26,27 surgery, and trauma 28,29 that may augment the activation or production of complement factors, including C5. Our results also highlight that some patients may require a lower dosage and/or longer intervals between doses, which should only be explored through well-designed prospective controlled trials.…”

Protective Mechanical Ventilation during General Anesthesia for Open Abdominal Surgery Improves Postoperative Pulmonary Function

“…48,49 Another recent study, concerning the inflammatory response in major abdominal surgery, reveals that there are no statistically significant differences between total intravenous anesthesia and inhalational anesthesia. 50 Finally, the baseline pulmonary functional test results were a bit lower than predicted, likely due to the method of measurement. However, we believe that this did not affect the interpretation of our data, because we investigated the evolution of pulmonary functional tests with time in the two study groups.…”