Local and systemic immune response to surgery under balanced anaesthesia in children

Abstract

We studied perioperative changes in the immune response and compared changes in the peripheral blood with those in the wound in 20 boys (0.5-3 years) during elective inguinal surgery under balanced anaesthesia. Blood samples were drawn before premedication, immediately, and 4 or 24 h after anaesthesia. Cells from the wound were harvested with the Cellstick device, removed from the wound 4 (n=10) or 24 h (n=10) after anaesthesia. We found decreased lymphocyte counts in the peripheral blood, increased percentages of activated T lymphocytes and B lymphocytes, and decreased percentages of total T lymphocytes, T helper cells and T cytotoxic cells. The percentages of T helper cells and B lymphocytes were lower in the wound than in blood. Mitogen-induced lymphocyte proliferative responses decreased. This study demonstrates perioperative changes in the immune response in children and, as a new finding, that immune effector cells in the blood and in the wound are in a dynamic balance.

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

“…A second study by Salo et al . (29) compared immunological changes between peripheral blood and surgical wound fluids in 20 young children undergoing elective surgery under balanced anesthesia. In the peripheral blood, the percentage of PMNs increased at the end ( P < 0.05) and 4 h after anesthesia ( P < 0.01), but decreased between 4 and 24 h ( P < 0.01).…”

“…Studies examining lymphoproliferative responses after surgery and anesthesia in pediatric patients show conflicting results. Some depict a transient hyporesponsiveness to certain mitogens, while others show an increase or fail to show any modulation (12,20,23,25,29,31). Importantly, all studies demonstrate a short‐lived and reversible influence on lymphoproliferative responses that mostly return to preoperative values within 2 days.…”

“…Moreover, since anesthesia and surgery are in a chronological time sequence, it remains problematic to discriminate which from anesthesia or surgery mostly modulates the immune system. To avoid this question, some studies measured immune markers after the induction of anesthesia but before the onset of surgery (19)(20)(21)(22)(27)(28)(29)(30)33,34), or during laparoscopic procedures which are known to exert less immunomodulatory influences than laparotomy (35). Surgical (35)(36)(37)(38)(39)(40) or psychological stress (41,42) may affect immune responses and may play a greater role in the modulation of immunity, as previously suggested (3,(43)(44)(45).…”

The Effects of Isoflurane and Sevoflurane on Immune System in Minor Surgical Interventi̇ons

“…In another study, even minor operations cause immune changes under balanced anaesthesia in children (7). Although the controversial data arising whether the immune effect of surgery has depended on anaesthesia or surgical trauma, it is possible to compare the immune interaction of different anesthetic approaches by evaluating similar patient groups and extend of surgery.…”

Anesthesia in an infant with a CINCA syndrome

“…In clinical practice anesthesilogists will face an increasing number of children with autoinflammatory syndromes due to progress in genetic diagnostics (1) and in knowledge about interaction of surgical stress, anesthesia and immune modulation (3). In these children a preoperative evaluation regarding to difficult airway management and to acute upper respiratory tract or other acute infection has to be provided.…”