Effects of Intraoperative Hypothermia on the Incidence of Post-operative Infection and Responses of Peripheral White Blood Cells / 대한마취과학회지

BACKGROUND: Hypothermia occurs commonly during surgery. An increased incidence of hypothermia- induced morbidity of surgical patients has been reported. Immunosuppression has also been demonstrated after major surgery. Therefore, we investigated the rate of infection and the changes of white blood cells depending on body temperature during a gastrectomy. METHODS: Sixty patients were randomly divided into be warmed intraoperatively with a circulating warm water mattress (group 1) or warm intravenous fluid/humidifier filter/circulating warm water mattress (group 2). Core temperature was recorded every 15 min during surgery and every 30 min in the recovery room. Blood samples for measurement of white blood cells were obtained preoperatively, immediately, post-op day 1 and day 2 after surgery. RESULTS: Group 1 began to have a decrease in temperature at 30 min after surgery and a significantly lower temperature than group 2 during the surgery and 60 min in the recovery room (P<0.05). Compared with preoperative values, surgery caused an increase in neutrophils, and a decrease in lymphocytes in both groups (P<0.05). Compared with group 2, more concentrations of neutrophils and less concentration of lymphocytes and monocytes were found in group 1 on the post-operative 2nd day (P<0.05). Fever above 37.3degrees C was found in 17 of 30 patients in group 1, but in only 14 of 30 patients in group 2. Pneumonia (one patient), urinary tract infection (one) and surgical wound infection (two) were only found in group 1, but the incidence of infection was not statistically significant between the groups. CONCLUSIONS: Intraoperative hypothermia was associated with a delayed recovery of changes in white blood cells.

Comparative Study of Immunologic Parameters between Spinal and Epidural Anesthesia for a Cesarean Section / 대한마취과학회지

BACKGROUND: Surgical stress and anesthesia can cause postoperative immunosuppression. T helper lymphocytes play a central role in the immune response. Cytokines secreted from T helper type-1 (Th1) and Th2 influence patients' morbidity. The purpose of the current study was to compare the effect of spinal anesthesia with epidural anesthesia on the T helper cell and cytokine secretions following cesarean section. METHODS: Forty-four patients were randomly divided into two groups. Total lymphocytes, T helper cells, and T helper type-1 and type-2 cytokines, interleukin-2 (IL-2), interferon gamma (IFN-gamma), and IL-4 and IL-10 in the supernatant of CD4 cells stimulated with phytohemagglutinin were identified by using an enzyme-linked immune assay. Blood samples were obtained before surgery, 1, 3, and 24 h after the start of surgery. RESULTS: Significant decreases in lymphocytes and CD4 cells at 3 and 24 h after the start of surgery were seen in epidural anesthesia. The Th1 response, IFN-gamma and IL-2 secretions were detected in 9 patients, in the spinal group, and 9 and 14 patients in the epidural group, respectively. There were no differences in the Th1 responses between the groups as well as within the groups. Th2 cytokine, IL-10 response in the higher concentration group receiving spinal anesthesia decreased significantly over the three time points studied, but decreased only at 24 h in the epidural group. CONCLUSIONS: Our results show a possible different immune response profile between the spinal and epidural group: a decreased CD4 level in the epidural group and decreased IL-10 levels in the spinal group according to the time period after surgery.