Do volatile inhalation anesthetics modify the immune response in surgical patients?

Anesthesia and surgery suppresses immune response which can reveal itself in complicated forms like allergy, infections etc. This impact can further increase the morbidity of surgical procedures. A prospective study was designed in minor surgical patients to elucidate the immunological responses and compare the immunological end-results of inhalation anesthetics halothane, isoflurane and sevoflurane with the aim of clarifying most suitable agent providing less immune changes. Forty five adult male patients without any immunological compromise and undergoing minor surgery [herniorraphy] were included. After the same induction technique, patients received halothane based general anesthesia GA [n: 15], isoflurane based GA [n: 15] or sevoflurane based GA [n: 15]. Laboratory assessment included stress hormones [epinephrine, norepinephrine and cortisol], cytokines [interleukin IL-2, IL-6 and IL-10], and cellular elements [white blood count, lymphocytes, T-lymphocytes subgroups CD4, CD8 and natural killer NK-cells]. The blood samples were withdrawn just preoperative, 30 min after induction, just after recovery, 6 h and 24 h postoperative. There were significant increases in plasma epinephrine level [P < 0.05], norepinephrine level [P < 0.01] and plasma cortisol level [P < 0.01] in all groups. Isoflurane anesthesia was associated with significantly higher concentrations of cortisol when compared to sevoflurane and halothane. In all groups, interleukin IL-2, IL-6 were significantly increased after surgery [each group P < 0.05], While IL-10 did not change significantly. Leukocyte counts were unaffected in all groups. While lymphocytes significantly decreased in all groups, it decreased significantly in isoflurane group in relation to halothane and sevoflurane. Lymphocyte subgroups CD4 and CD8 measurements were stable. NK cells significantly decreased in all groups, it decreased significantly in isoflurane group in relation to halothane and sevoflurane. In the clinical setting of a low stress procedure, the use of isoflurane anesthesia apparently increases cortisol level, this phenomenon was associated with less favorable metabolic and immune response when compared with sevoflurane or halothane. Further studies are required to verify whether sevoflurane anesthesia might maintain such advantages in more critical surgical procedures on severely ill, immunocompromised and/or malnourished patients

Autoclaved gelatin [haemagel] versus 6% hydroxyethyl starch 200/0.5 [Haes-steril] for plasma volume expansion in critically-ill patients

Synthetic colloids are used to optimize hemodynamics in the critically ill patients and a debate about the most suitable one is still present. The influence of short term infusion of autociaved gelatin [Haemagel] and 6% hydroxyethyi starch 200/0.5 [Haes-steril] on hemodynamic, respiratory, coagulation, renal and oncotic parameters were examined in a prospective randomized study. Thirty patients suffering from systemic hypoperfusion due to sepsis in ICU of Suez Canal University Hospital were assigned into 2 equal groups. In GEL group; 1000 ml of Haemagel was infused within an hour, while in HES group: 1000 ml of 6% Haes-steril 200/0.5 was given within an hour The hemodynamic, respiratory, hematological. coagulation, renal and colloidal osmotic pressure parameters were recorded before and after infusion of both colloids. There was a significant similar increase in hemodynamic variables [Mean arterial pressure, central venous pressure, cardiac index, stroke volume index and left ventricular stroke work index] in both groups. Also, a significant improvement in tissue perfusion as judged by decreased arterial lactate was found. There were no significant differences in any of the measured respiratory parameters [respiratory rate, arterial oxygen saturation, arterial blood gases and intrapulmonary shunt] in the studied groups. No significant intergroup difference in any haemodynamic or respiratory variable was demonstrated. A significant expansion in plasma volume as indicated by the significant reduction in haematocrit was detected. There were insignificant changes in coagulation profile [prothrombin time, activated partial thrombopiastin time, bleeding time and fibrinogen] in either group except the platelet count which was significantly reduced in both groups without any recorded bleeding complications. Creatinine, blood urea nitrogen, sodium and potassium didn't change and were comparable in the two groups Colloidal osmotic pressure and urine output increased significantly in either group. Anaphylactic reactions were not observed in any of the patients However, no significant differences between both groups in haematological. coagulation, renal and oncotic parameters were found. Both autoclaved gelatin [Haemagel] and 6% hydroxyethyl starch 200/0.5 [Haes-steri!] are safe and equally effective colloids for plasma volume expansion tn critically ill patients without apparent adverse effects on respiration, coagulation and renal functions