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Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia - a randomized study / Artroplastia total do joelho induz apoptose em linfócitos de sangue periférico e não é evitada por anestesia regional - Estudo randomizado
Kosel, Juliusz; Rusak, Malgorzata; Golembiewski, Lukasz; Dabrowska, Milena; Siemiatkowski, Andrzej.
  • Kosel, Juliusz; Medical University of Bialystok. Department of Anesthesiology and Intensive Therapy. Bialystok. PL
  • Rusak, Malgorzata; Medical University of Bialystok. Department of Anesthesiology and Intensive Therapy. Bialystok. PL
  • Golembiewski, Lukasz; Medical University of Bialystok. Department of Anesthesiology and Intensive Therapy. Bialystok. PL
  • Dabrowska, Milena; Medical University of Bialystok. Department of Anesthesiology and Intensive Therapy. Bialystok. PL
  • Siemiatkowski, Andrzej; Medical University of Bialystok. Department of Anesthesiology and Intensive Therapy. Bialystok. PL
Rev. bras. anestesiol ; 66(2): 133-139, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-777398
ABSTRACT
ABSTRACT

BACKGROUND:

Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis.

METHODS:

34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy.

RESULTS:

Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery.

CONCLUSION:

Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique.
RESUMO
RESUMO JUSTIFICATIVA E

OBJETIVO:

Dentre as muitas alterações causadas por uma ferida cirúrgica, uma das menos estudadas é a imunossupressão pós-operatória. Esse fenômeno é uma causa importante das complicações infecciosas relacionadas à cirurgia, como infecção do sítio cirúrgico ou pneumonia nosocomial. Um dos mecanismos que levam à imunossupressão pós-operatória é a apoptose de células imunológicas. Durante a cirurgia, a anestesia se destina a minimizar as alterações prejudiciais e manter a homeostase perioperatória. O objetivo deste estudo foi avaliar o efeito da técnica anestésica usada para artroplastia total de joelho sobre a apoptose em linfócitos de sangue periférico no pós-operatório.

MÉTODOS:

Trinta e quatro pacientes submetidos à artroplastia total primária de joelho foram randomicamente designados para dois protocolos de anestesia regional raquianestesia e bloqueio combinado raqui-peridural. Onze pacientes submetidos à artroplastia total do joelho sob anestesia geral formaram o grupo controle. Antes da cirurgia, logo após a cirurgia, durante o primeiro dia de pós-operatório e sete dias após a cirurgia, amostras de sangue venoso foram colhidas e o estado imunológico do paciente foi avaliado com o uso deflow cysts 87 m, juntamente com apoptose de linfócitos com o uso de microscopia de fluorescência.

RESULTADOS:

Apoptose em linfócitos de sangue periférico foi observada imediatamente no pós-operatório e acompanhada por uma redução do número de células T e B. Não houve diferença significativa no número de linfócitos apoptóticos de acordo com o protocolo anestésico. Alterações no número de células T CD3/8 e no número de linfócitos apoptóticos foram observadas no sétimo dia após a cirurgia.

CONCLUSÃO:

Apoptose em linfócitos de sangue periférico é um evento precoce no período pós-operatório que dura até sete dias e não é afetado pela escolha da técnica anestésica.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Apoptosis / Arthroplasty, Replacement, Knee / Anesthesia, Epidural / Anesthesia, Spinal Type of study: Controlled clinical trial Limits: Aged / Aged80 / Female / Humans / Male Language: English Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2016 Type: Article Affiliation country: Poland Institution/Affiliation country: Medical University of Bialystok/PL

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Full text: Available Index: LILACS (Americas) Main subject: Apoptosis / Arthroplasty, Replacement, Knee / Anesthesia, Epidural / Anesthesia, Spinal Type of study: Controlled clinical trial Limits: Aged / Aged80 / Female / Humans / Male Language: English Journal: Rev. bras. anestesiol Journal subject: Anesthesiology Year: 2016 Type: Article Affiliation country: Poland Institution/Affiliation country: Medical University of Bialystok/PL