[Effects of epidural anesthesia on stress-induced immune supression during major corrective spine surgery].

STUDY DESIGN: A prospective, randomized study wias performed to compare two anesthetic methods. OBJECTIVE: To evaluate the effect of epidural analgesia on postoperative pain, endocrine- metabolic and inflammatory stress response and cellular inmmune responses during major corrective spine surgetry. METHODS: The study included 350 patients aged 15 to 65 who were randomly allocated to two equal groups. Group I (n=205) had continuous epidural analgesia (E4) and sevoflurane anesthesia during surgety and continuous epidural analgesia with ropivacaine and fentanil after surgery; Group 2 (n= 145) had general anesthesia with sevoflurane and fentanil and systemic administration of opioids after surgery. Patient pain, PONV syndrome, mobility, and satisfaction were measured after surgery along with plasma levels ofcortisol, ghmcose, interleukins IL-1ß, IL-6, and IL-10 during and after surgemy C-reactive protein (CRP), and cell-surface receptor expression of immune cells (cluster of differentiation) HLA-DR+/CD3-, HLA-DR+/CD3+, HILA-DR, CD3, CD4, CD8, CD16, CD19 CD16/56+, and CD16/56+/CD3+) were measured perioperatively. RESULTS: In group 1, there were significantly less pain, less nausea, earlier mobility, and higher satisfaction than those in group 2. Group I has also demonstrated significantly less plasma levels of glucose, cortisol, CRP, IL-lß, IL-6, IL-10 at various stages. The ratio of CD4/CD8 (p=0.001) and B cells (p=0.01) have increased by postoperative day 3 in group 1. NK-cells (CD16/56+) have decreased significantly by day 3 after surgery (p=0.001) compared to the group 2. T-lymphocytes, (CD3) have decreased in all patients, but they were significantly lower in patients receiving opioids, compared wiith EA. CONCLUSIONS: Polerfulr afferent stimulation in major corrective spine surgery accompanied by immunosuppression for at least a wieek after surgery. EA reduces the surgical stress response, prevents postoperative lymphocyte apoptosis and thus, increases stress and infectious resistance.

Serum levels of different forms of soluble CD38 antigen in burned patients.

The level of the total and dimeric (oligomeric) forms of soluble CD38 antigen (sCD38) has been determined by an ELISA sandwich method in serum from burned patients (n=18) and healthy volunteers (n = 25). The serum level of total sCD38 was insignificantly increased in patients at the stage of burn shock (135 +/- 10.8 U/ml, mean +/- S.E.M.) and significantly decreased between 4 and 14 postburn days in comparison with volunteers (69.5 +/- 10.8 U/ml versus 121 +/- 7.8 U/ml, P < 0.05). The serum level of soluble dimeric CD38 in burned patients was statistically lower than normal during all periods of observation (45.3 +/- 8.8 and 130 +/- 6.2 U/ml, respectively, P < 0.01). The relative number of CD38(+) lymphocytes was increased during the period of shock in comparison with healthy volunteers (21 +/- 1.6% versus 13 +/- 1.1%, P < 0.05). There were no correlations between number CD38(+) lymphocytes and total sCD38 or dimeric sCD38 serum levels. These data suggest that the mCD38 expression and serum level of total sCD38 are a markers the early postburn lymphocytes activation. The decrease of dimeric sCD38 level can reflect its dissociation to monomeric form in burned patients.

Peripheral blood lymphocytes immunophenotype and serum concentration of soluble HLA class I in burn patients.

The level of the soluble form of histocompatibility class I antigens, associated with beta(2)-microglobulin (sHLA-I) has been determined by an ELISA sandwich method in serum from burned patients (n=42) and healthy volunteers (n=30). The sHLA-I level was insignificantly increased in burn patients at the stage of burn shock (1284+/-324U/ml, mean+/-S.E.M.) and after day 28 postburn (1368+/-258U/ml) compared to volunteers (1150+/-90U/ml). At the same time a decrease of sHLA-I levels between 4 and 14 days (638+/-178U/ml) was determined (P<0.05). Increased levels of sHLA, though not significant, were detected in patients with TBSAB >70% in comparison to patients with TBSAB from 30 to 70% during burn shock (1493+/-528 and 1075+/-339U/ml, respectively). Expression of membranous HLA class I antigens (mHLA-I) in peripheral blood lymphocytes (PBLs) was assayed simultaneously by indirect immunofluorescence. The number of CD3(+), CD4(+), CD8(+), CD25(+), CD71(+) and CD26(+) lymphocytes was also evaluated. The expression of mHLA-I in PBLs was increased significantly in patients with TBSAB <70% at early postburn period. Daily monitoring showed that the relative numbers of CD25(+) and CD71(+) lymphocytes in patients varied greatly within short intervals of time during burn shock. The data obtained suggest that mHLA-I expression can reflect postburn lymphocyte activation. The serum content of sHLA-I does not depend on lymphocyte number or activated lymphocyte number in peripheral blood at burned patients.