Does isoflurane anesthesia alter immuno-modulatory response in schistosomal Patients?. Assessment of serum pro- and anti-inflammatory cytokine balance

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immuno-suppressive effects, can influence long term disease progression, morbidity, and mortality. Literature on postoperative immune response in schistosomiasis patients is scarce. The aim of this study was to assess the impact of isoflurane anesthesia on pro- and anti-inflammatory cytokine balance in schistosomal patients undergoing minor procedures. The study was conducted on 24 patients [ASA class I-II] scheduled for elective urologic endoscopic procedures. Patients were divided into two groups 12 patients each: control group [n=l2] and patient group [n=l2]. Anaesthesia was induced by a bolus dose of sufentanil 0.2 micro g.kg -1, thiopentone sodium 5mg.kg -1, vecuronium 0.1 mg.kg -1 and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 micro g.kg -1 when indicated. Venous blood samples were obtained from each patient: before induction, fifteen minutes, one hr after induction and 24 hrs after surgery. Plasma levels of IL-1 beta, TNF-alpha, IL-8, IFN-lambda, IL-1ra and TNF-BP1, as well as stress hormones [cortisol and prolactin] were measured. As for pro- and anti-inflammatory cytokine balance, the overall end- result was a rise at 24 hr postoperatively, in the level of TNF-alpha [a key pro-inflammatory cytokine] and IFN-lambda, as well as both anti-inflammatory cytokines [IL-Ira and sTNF-R1]. The anti-inflammatory response was more conspicuous in the patients than controls

influence of isofluorane anesthesia on the balance between serum pro- and anti-inflammatory cytokines

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immunosuppressive effects, can influence longterm disease progression, morbidity, and mortality. The effects of surgery, surgical stress, and anesthesia compromise the optimal function of the immune system. The purpose of this study was to clarify the effect of isofluorane anesthesia on the balance between serum pro- and anti-inflammatory cytokines in schistosomal patients undergoing minor endoscopic urological procedures. Our study was conducted on 24 patients [ASA class I-II] scheduled for elective urologic endoscopic procedures of more than one-hour duration. Patients were divided into two groups control group [n=12] and schistosomal group [n=12]. Anaesthesia was induced in by a bolus dose of sufentanil 0.2 microg.kg[-1], thiopentone sodium 5mg.kg[-1], vecuronium 0.1 mg.kg-1 and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 microg.kg-l. Four venous blood samples were obtained from each patient: Before induction, 15 minutes after induction and before start of surgical procedure, at the end of anesthesia and surgery and 24 hour after operation. Scrum pro-inflammatory cytokines: tumor necrosis factor alpha [TNF alpha], interleukin-lbeta [IL-lbeta], interferon gamma [IFN-y], and interleukin-8 [IL-8] and serum anti-inflammatory cytokines: interleukin-1-receptor antagonist [IL-Ira] and soluble tumor necrosis factor receptor-1 [sTNF-RI]; as well as stress hormones [cortisol and prolactin] were measured by ELISA. As for pro- and anti-inflammatory cytokine balance in our study, the overall end-result in both groups was a rise at 24 hours postoperatively, in the level of the pro-inflammatory cytokine TNF-alpha and both anti-inflammatory cytokines investigated IL-Ira and sTNF-RI. The rise of the anti-inflammatory cytokines was more conspicuous in the schistosomal than non-schistosomal patients. In conclusion, we suggest that inhalational anesthesia using isoflurane, offers a minimal proinflammatory harmful response with a good postoperative antiinflammatory one especially in schistosomal patients, thus fulfilling the ultimate goal of proposing strategies for better patient outcome

Impact of small dose ephedrine versus priming principle on pharmacodynamics of cistracurium

This study aimed to compare the impact of adding a small dose ephedrine versus priming technique, with a bolus dose, on the onset time, recovery index and clinical duration of cisatracurium. Also, the intubating conditions and hemodynamic changes were evaluated. Forty-five patients were randomly assigned and allocated into three groups of 15 patients each. Induction was achieved in all three groups by fentanyl 1-2 mug/kg and propofol 2 mg/kg. Patients in group A received a bolus dose of 100 mug/kg cisatracurium after induction. Patients in group B were given ephedrine [70 pg/kg] 5 seconds before induction, then 100 mug/kg cisatracurium. Patients in group C were given priming dose 15 mug/kg cisatracurium before induction, followed by 8.5 mug/kg 4 minutes after priming dose. Maintenance was done by NO2/O2, halothane. Neuro-muscular blockade was monitored using TOF- Guard [Organon-Teknika] by recording the acceleration of the thumb resulting from supramaximal stimulation of ulnar nerve at 2 Hz for 2 seconds at 10-second intervals. Anesthesia was induced by fentanyl and propofol and then maintained by 0.870 halothane in fresh gas flow [66% N20 in 33% 02]. In conclusion, both techniques, priming and small dose ephedrine, produced significant reduction in onset time of cisatracurium as compared to using bolus dose. This was more eminent in the priming group, there was a significant prolongation of clinical duration as well and was void of adverse hemodynamic effects