Influence of anesthesia on immune responses and its effect on vaccination in children: review of evidence

Abstract

Anesthesia and surgery exert immunomodulatory effects and some authors argue that they may exert additive or synergistic influences on vaccine efficacy and safety. Alternatively, inflammatory responses and fever elicited by vaccines may interfere with the postoperative course. There is a lack of consensus approach among anesthesiologists to the theoretical risk of anesthesia and vaccination. Few studies have assessed the influence of anesthesia and surgery on pediatric vaccine responses. We have undertaken an extensive review of articles published in English between 1970 and 2006 meeting the criteria: measurement of immune parameters following general anesthesia in children. By searching the major medical databases (OVID Medline, PubMed, ISI Web of Science) and references cited in the articles themselves, among 277 articles obtained none examined directly the influence of anesthesia/surgery on vaccine responses. Only 16 original reports assessed the influence of several anesthetic agents on various markers of immunity including lymphocyte numbers and functions. These results are reinterpreted here in view of our current understanding of the immune mechanisms underlying vaccine efficacy and adverse events. We conclude that the immunomodulatory influence of anesthesia during elective surgery is both minor and transient (around 48 h) and that the current evidence does not provide any contraindication to the immunization of healthy children scheduled for elective surgery. However, respecting a minimal delay of 2 days (inactivated vaccines) or 14-21 days (live attenuated viral vaccines) between immunization and anesthesia may be useful to avoid the risk of misinterpretation of vaccine-driven adverse events as postoperative complications.

Resurgence of Vaccine-Preventable Diseases in the United States: Anesthetic and Critical Care Implications

“…Based on a review of 16 studies published between 1970 and 2006, a Swiss group proposed that elective surgery in healthy children should be delayed for 2 days after administration of inactivated vaccines and 2 to 3 weeks after live attenuated viral vaccines, mainly to avoid confusion in the interpretation of postoperative symptoms such as fever. 31 The Association of Paediatric Anaesthetists of Great Britain and Ireland also recommends delaying elective surgery for 2 days after immunization with inactivated vaccines. They do not recommend delaying surgery after immunization with live vaccines because of a lower risk of febrile reactions (Supplemental Digital Content, Ref.…”

Clinical Analysis of Fever, Headache, and Gastrointestinal Symptoms after Endosaccular Coil Embolization in Patients with Unruptured Cerebral Aneurysms— A Study of “Post Coiling Syndrome”

“…11,12) Importantly, almost all such studies reported a short-lived and reversible influence on the immune reaction that mostly returned to preoperative values within 24 h. Given this, in our study, we applied the PCS diagnostic criteria based on the scoring of such symptoms between 24 h and 48 h after the operation. 7) We also suspected that some symptoms were caused by nephropathy induced by the contrast medium and radiation sickness.…”

Therete mirabileof the tail, an effective site for sampling sterile blood from armadillos (Dasypodidae, Xenarthra)

“…Although the use of anesthetics is a useful option due to the exceptional anatomy and physical resistance of armadillos, it may reduce the quality of the sample and affect the animal's health. In addition, anesthetic interference over lymphocyte development in culture has been described (Siebert et al 2007). In our experience, culture blood samples obtained from animals under ketamine chloride anesthesia showed low performance in all cases.…”

“…The quality of a blood sample is conditioned by: (1) the great diversity of body size in armadillos and the correlation between the maximal collection volume, the size of blood vessels and the weight of the animal (Belcher & Harriss 1957); (2) necrotic factors and biological contaminants and also the preservation of the cell viability and morphology, which are extremely important in cell culture; (3) the use of anesthesia that can interfere in the experimental use of the blood (Siebert et al 2007). …”