Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute‐phase protein responses in patients undergoing cardiac surgery

Christensen, Vibeke Brix; Tønnesen, Else; Sørensen, Inge Juul; Bilfinger, Thomas V.; Sánchez, Ricardo Gil; Stefano, George B.

doi:10.1111/j.1399-6576.1998.tb05082.x

Cited by 93 publications

(54 citation statements)

References 24 publications

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“…This response seems to be paralleled by IL-8 as a reaction to major surgery [26]. No detectable TNF-α response in plasma has so far been demonstrated following surgery apart from cardiac surgery [27].…”

Section: Discussionmentioning

confidence: 99%

Systemic and Cell-Mediated Immune Response after Laparoscopic and Open Cholecystectomy in Patients with Chronic Liver Disease

Lausten

Ibrahim²,

Elsefi³

et al. 1999

Dig Surg

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Background: As impaired immune function observed in cirrhotic patients is known to increase the risk of postoperative complications, the immunological response to surgery was investigated. Methods: Twenty-eight patients with postnecrotic liver cirrhosis or chonic hepatitis C and symptomatic gallstone disease were randomly allocated to laparoscopic (LC) or open cholecystectomy (OC). Changes in concentrations of cytokines (TNF-α, IL-1β, IL-6, IL-8 and IL-10) were followed and the effect of surgical trauma on the distribution of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD19) and NK cell cytotoxicity were measured. Results: After OC a decrease in circulating CD3 (p < 0.05) and CD4 (p < 0.05) and an increase in CD19 (p < 0.05) cells were detected in contrast to LC after which only CD16 cells decreased (p = 0.05). The number of CD3 cells was higher after LC than after OC (p < 0.01), whereas the number of CD19 cells was higher after OC than after LC (p < 0.01). NK cell cytotoxicity was reduced after LC (p < 0.05). In cirrhotic patients circulating cytokines were unaffected by OC, whereas TNF-α (p < 0.05) and IL-1β (p < 0.05) were reduced after LC. In chronic hepatitis IL-1β decreased after OC (p = 0.05) and IL-10 was significantly higher after LC than following OC (p < 0.05). Conclusion: The immune response is less pronounced after a laparoscopic procedure compared to a conventional approach in patients with chronic liver disease.

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Section: Discussionmentioning

confidence: 99%

Systemic and Cell-Mediated Immune Response after Laparoscopic and Open Cholecystectomy in Patients with Chronic Liver Disease

Lausten

Ibrahim²,

Elsefi³

et al. 1999

Dig Surg

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“…In patients with established SIRS or organ dysfunction both pro-and anti-inflammatory cytokines are detectable in markedly increased amounts in peripheral blood. We have previously demonstrated that the CPB procedure itself induces a well-defined pro-and anti-inflammatory cytokine response in neonatal pigs (5) analogous to the human response to cardiac surgery performed during CPB (6,7). However, plasma levels of cytokines do not necessarily reflect tissue concentrations or their effect at organ level and may therefore be a poor reflection of the processes occurring at organ level.…”

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confidence: 99%

Plasma cytokines do not reflect expression of pro‐ and anti‐inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs*

Christensen

Vestergaard²,

Chew

et al. 2003

Acta Anaesthesiol Scand

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“…Im Plasma herzchirurgischer Patienten, bei denen zwischen einem Anästhesieregime mit hoch bzw. niedrig dosiertem Fentanyl unterschieden wurde, war die Konzentration von IL-8, IL-6 und IL-10 bei beiden Narkoseverfahren vergleichbar [12].…”

Section: Fehlende Direkte Immunmodulation Durch Fentanylunclassified

Opioide und Immunsuppression

Welters¹

2003

Der Anaesthesist

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First observations that opioids may have disadvantageous effects on the immune response have been made more than 100 years ago. Today the immunosuppressive effect of morphine is well established.Drug-induced immunomodulation is of growing importance in modern anesthetic concepts. The reduced stress response observed after morphine application contributes to this effect as well as direct impairment of immune effector cells such as bactericidal activity, intracellular killing,proliferative response or cytokine synthesis. Opioid-induced immunomodulation is mediated by opioid receptors found on immunocytes and in the central nervous system.A negative feedback mechanism via the hypothalamo-pituitary-adrenal axis may potentiate the direct inhibitory effect of morphine on the immune response.A final statement regarding the clinical relevance of opioid-induced immunosuppression cannot be made at this point, since the existing clinical data are preliminary and inconclusive.Therefore, further clinical studies are mandatory to elucidate the influence of opioid treatment on immune regulation in different clinical settings in anesthesia, critical care, pain therapy and emergency medicine. Further investigations may help to not only provide sufficient analgesia by application of opioids, but also to assess advantages and disadvantages on immune function.

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Effects of anaesthesia based on high versus low doses of opioids on the cytokine and acute‐phase protein responses in patients undergoing cardiac surgery

Cited by 93 publications

References 24 publications

Systemic and Cell-Mediated Immune Response after Laparoscopic and Open Cholecystectomy in Patients with Chronic Liver Disease

Systemic and Cell-Mediated Immune Response after Laparoscopic and Open Cholecystectomy in Patients with Chronic Liver Disease

Plasma cytokines do not reflect expression of pro‐ and anti‐inflammatory cytokine mRNA at organ level after cardiopulmonary bypass in neonatal pigs*

Opioide und Immunsuppression

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