Effect of epidural and intravenous clonidine on the neuro-endocrine and immune stress response in patients undergoing lung surgery

Abstract

The effects of intravenous and epidural clonidine, 4 microg kg-1, combined with epidural morphine, 40 microg kg-1, on the neuro-endocrine and immune stress responses to thoracic surgery are reported. A control group received only epidural morphine. Anaesthesia was induced and maintained with propofol. Catecholamines, vasopressin, cortisol, beta-endorphin concentrations and leucocyte counts were measured before drug administration, immediately after intubation of the trachea, after thoracotomy and at the end of surgery. Catecholamines did not change in any of the groups. The other stress hormones increased during surgery, the pattern being similar in the three groups. Total leucocyte and neutrophil counts were increased in all groups at the end of surgery, but the increase was least in the epidural clonidine group. The number of lymphocytes was reduced at the end of surgery in the epidural and intravenous group, compared with the control group in which the number of lymphocytes did not change. The effects are more pronounced with epidural than with intravenous administration. We conclude that clonidine can modulate the immune stress response to thoracic surgery.

Opioids and clonidine modulate cytokine production and opioid receptor expression in neonatal immune cells

“…Many similar effects have also been reported for clonidine 35, 36, 37, 38 . Because cytokine production is a crucial component of the innate immune response which is essential in neonates, the potential down-regulation of cytokine production by neonatal immune cells is of clinical significance in the NICU setting.…”

The effects of deep and light propofol anesthesia on stress response in patients undergoing open lung surgery: a randomized controlled trial

“…Adrenocortical response is known to be directly proportional to the severity of surgical trauma and lung surgery evokes a high stress response because it involves major surgical injury and OLV-associated pulmonary inflammation. Thus, despite successful attenuation of adrenocortical response to gynecological surgery [ 8 , 9 ], propofol anesthesia at infusion rates of 4-12 mg/kg/h did not attenuate adrenocortical response to thoracic surgery [ 14 , 15 ]. These reports indicate that clinically relevant concentrations of propofol are unlikely to attenuate HPA axis activation to major thoracic surgery.…”

Selective Neurogenic Blockade and Perioperative Immune Reactivity in Patients Undergoing Lung Resection

“…38 α 2 -Adrenergic receptor agonists, such as clonidine, reduce anaesthetic requirements, attenuate sympathoadrenal responses during surgery and reduce plasma noradrenaline concentrations by stimulation of presynaptic α 2 -adrenoceptors. 66,67 Perioperative treatment with clonidine inhibits the hypothalamic-pituitary-adrenal axis 68 and causes a postoperative shift towards a Th2 cytokine response. 69 -71 Opioids impair the immune system; 72,73 on the other hand, morphine is known to protect from stress by inhibiting the hypothalamic-pituitary-adrenal axis.…”