The Effects of Anesthetic Techniques and Postoperative Pain Control on the Response of the Stress and Immune System in Cesarean Section Patients / 대한마취과학회지

BACKGROUND: Surgical trauma may affect the host immune system. We have examined the time course of circulating interleukin-6 (IL-6) and cortisol in patients undergoing a cesarean section (c/s) to determine if the anesthetic techniques and postoperative pain control have an effect on the response of the stress and immune system. METHODS: Thirty healthy women undergoing c/s were randomly allocated to three groups. Group I (n = 10) was provided with general anesthesia, group II (n = 10) with epidural anesthesia and group III (n = 10) with epidural anesthesia plus continuous epidural analgesia for postoperative pain control. Blood samplings for IL-6 and cortisol were conducted 4 times in all patients: preoperation, 1 h, 3 h and 24 h after skin incision. RESULTS: The mean concentrations of IL-6 were significantly increased in all three groups at 3 h and 24 h after the skin incision, but there were no significant differences among the three groups. The mean concentrations of cortisol were significantly increased in three groups at 1 h and 3 h after the skin incision, but there were no significant differences among the three groups. CONCLSIONS: No significant differences among three groups were seen. Thus, We couldn't determine that anesthetic techniques and postoperative pain control had a significant effect on the response of the stress and immune system.

The Effects of Oral Clonidine on the Cytokines and Stress Hormone Responses in Patients Undergoing Abdominal Hysterectomy / 대한마취과학회지

BACKGROUND: Surgery cause alterations in immune and neuroendocrine responses. Cytokines and stress hormones are importanat mediators which modulate the various immune reactions. The aim of present study is to investigate whether clonidine premedication can affect on the concentrations of cytokines and stress hormones in abdominal hysterectomy patients. METHODS: Twenty two healthy women undergoing abdominal hysterectomy were randomly allocated to two groups: eleven control patients and eleven clonidine(0.15 mg) pretreated patients. Variations in blood cytokines, Interleukin-1beta(IL-1beta), IL-2, IL-6 and tumor necrosis factor-alpha(TNF-alpha), and stress hormones, cortisol and ACTH were studied. Blood sampling were conducted 4 times in each patient: after induction, after incision, after surgery 1 h and 3 h. Cytokines assays were carried out with commercially available ELISA kits, and cortisol with radioimmunoassay and ACTH with immunoradiometric assay. RESULTS: IL-1beta increased early and the concentrations of IL-1beta in clonidine treated group were significantly lower than control. The mean concentrations of IL-2 at 1 and 3 h after surgery were slightly higher than after induction in clonidine treated group. IL-6 increased significantly at 3 h after surgery in both groups. Clonidine lowered IL-6 during the whole period. TNF-alpha, and cortisol and ACTH concentraitons were not affected by clonidin. CONCLUSIONS: Clonidine pretreatment decreased IL-1beta and IL-6 concentrations, but not stress hormones in response to abdominal hysterectomy.