The influence of anaesthetic technique upon the immune response to hysterectomy

Abstract

Propofol, currently available as a lipid emulsion (Intralipid loo/), is widely used for induction and maintenance of general anaesthesia [ 11. We have recently evaluated the effects of total intravenous anaesthesia with propofol on the immune response during minor surgery [2] and found increased percentages of T helper lymphocytes in the blood after propofol anaesthesia but not after conventional balanced anaesthesia with thiopentone and nitrous oxide. T helper cells are a subset of T lymphocytes pivotal in augmenting both cell-mediated [3] and humoral immunity [4]. Major surgery causes changes in the immune response which are related to the extent of surgical trauma [5] and the neuroendocrine stress response [6]. In this study we compared the effects of propofol infusion anaesthesia and combined isoflurane anaesthesia on the immune response to abdominal hysterectomy. Patients and methodsWe studied 30 women (median age 47 years; range 36-65 years), ASA grades 1 or 2 scheduled for elective abdominal hysterectomy. The patients were allocated randomly to two groups. Patients with immunosuppressive treatment, malignant disease or marked obesity (weight exceeding the ideal body weight by 30% or more) were not studied.

Propofol infusion anaesthesia and the immune response in elderly patients undergoing ophthalmic surgery

“…The same phenomenon has previously been observed by us in middle-aged patients undergoing minor [4] and major surgery [9]. This has thus been a constant finding in our three studies where propofol and isoflurane or conventional balanced anaesthesia have been compared.…”

The effect of anaesthesia and surgery on plasma cytokine production

“…There is a lack of information as regards the independent influence of anaesthesia on cytokine production. The results of some workers support the hypothesis that opioid analgesics play an important role in the attenuation of the cytokine response [12,13]. Crozier et al [13] found that IL-6 production was both suppressed and delayed in patients receiving TIVA with propofol and alfentanil after abdominal hysterectomy.…”

Differential effects of propofol and isoflurane on the activation of T‐helper cells in lung cancer patients

“…Furthermore, the increased IFN-c ⁄ IL-4 ratio represents enhanced T-helper 1 differentiation in patients under propofol anaesthesia. Cortisol levels were significantly lower with propofol, which suggests that stress, is lower with propofol anaesthesia than with isoflurane anaesthesia [17,21].…”