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

ABSTRACT

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: