Comparison of two anesthetic techniques on the plasmatic levels of inflammatory markers

Alejandro Bravo-Cuellar; José Enrique Romero-Ramos; Georgina Hernández-Flores; Felipe de Jesús Romo-Pérez; Luis Bravo-Cuellar; José Manuel Lerma-Díaz

2007, Number 2

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Cir Cir 2007; 75 (2)

Comparison of two anesthetic techniques on the plasmatic levels of inflammatory markers

Bravo-Cuéllar A, Romero-Ramos JE, Hernández-Flores G, Romo-Pérez FJ, Bravo-Cuéllar L, Lerma-Díaz JM

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Language: Spanish
References: 28
Page: 99-105
PDF size: 68.47 Kb.

ABSTRACT

Background: The aim of this work was to determine and compare plasma levels of proinflammatory cytokines (IL-1β, IL-6 and TNF-α), C-reactive protein (CRP) and lipoperoxides in patients submitted to laparoscopic cholecystectomy under general anesthesia or regional anesthesia.
Methods: Two groups of 15 patients of both sexes were submitted to laparoscopic cholecystectomy either with general or regional anesthesia. In all cases we obtained three samples of plasma. The first sample was collected immediately before surgery, whereas the other samples were collected 60 min and 24 h after the cholecystectomy. Using commercial kits, plasma levels of IL-1β, IL-6 and TNF-α were quantified by ELISA, whereas lipoperoxides were determined by a colorimetric method. The ultrasensitive CRP was determined in the hospital by the Prestige 24I automated method.
Results: In all determinations, proinflammatory cytokines increased 24 h after surgery except plasma levels of IL-1β in the regional anesthesia group. Comparison of the two different groups showed that the general anesthesia group had a similar or higher quantity of proinflammatory cytokines and oxidative stress when compared to the regional anesthesia group (p ‹ 0.05). In contrast, plasma levels of CRP were lower in the general anesthesia group (p ‹ 0.005).
Conclusions: The type of anesthesia influences in a different manner the secretion of soluble mediators of inflammation. These observations may have important clinical repercussions.

REFERENCES

1. Tillett W, Francis JT. Serological reactions in pneumonia with a nonprotein somatic fraction of pneumococcus. J Exp Med 1930;52:561-585.
2. Nilsson J. CRP—marker or maker of cardiovascular disease? Arterioscler Thromb Vasc Biol 2005;25:1527-1528.
3. Lerma-Diaz JM, Hernandez-Flores G, Dominguez-Rodriguez JR, et al. In vivo and in vitro sensitization of leukemic cells to adriamycin-induced apoptosis by pentoxifylline. Involvement of caspase cascades and IkBa phosphorylation. Immunol Lett 2006;103:149-158.
4. de Bont N, Netea MG, Rovers C, et al. LPS-induced release of IL-1b, IL-1Ra, IL-6, and TNF-a in whole blood from patients with familial hypercholesterolemia: no effect of cholesterol-lowering treatment. J Interferon Cytokine Res 2006;26:101-107.
5. Pouniotis desviación estándar, Plebanski M, Apostolopoulos V, McDonald CF. Alveolar macrophage function is altered in patients with lung cancer. Clin Exp Immunol 2006;143:363-372.
6. Rittner HL, Machelska H, Stein C. Leukocytes in the regulation of pain and analgesia. J Leukoc Biol 2005;78:1215-1222.
7. Rittner HL, Brack A, Stein C. Pain and the immune system: friend or foe? Anaesthesist 2002;51:351-358.
8. Cervantes-Munguia R, Espinosa-Lopez L, Gomez-Contreras P, Hernandez-Flores G, Dominguez-Rodriguez J, Bravo-Cuellar A. Retinopathy of prematurity and oxidative stress. An Pediatr (Barc) 2006;64:126-131.
9. Halliwell B, Gutteridge JM, Cross CE. Free radicals, antioxidants, and human disease: where are we now? J Lab Clin Med 1992;119:598-620.
10. Bruce DL. Halothane inhibition of RNA and protein synthesis of PHA-treated human lymphocytes. Anesthesiology 1975;42:11-14.
11. Halabe-Cherem J, Malagon J, Wacher-Rodarte N, Nellen-Hummel H, Talavera-Pina J. Usefulness of the ASA scale and thoracic radiography as indicators of perioperative cardiovascular risk. Gac Med Mex 1998;134:27-32.
12. Ortega RA, Vandam LD. An anesthesia journey. J Clin Anesth 2005;17:399-402.
13. Hansen-Flaschen J, Cowen J, Polomano RC. Beyond the Ramsay scale: need for a validated measure of sedating drug efficacy in the intensive care unit. Crit Care Med 1994;22:732-733.
14. García H, Faure A, González AC. Tamaño de una muestra. Metodología de la investigación en salud. México: McGraw-Hill;2001. pp. 97-103.
15. López Andrade-Jurado A, Martín Ruiz JL, Bravo-Cuéllar A. Anestesia y respuesta inmune en el paciente quirúrgico. México: CUALTOS, Universidad de Guadalajara(México)-Universidad de Granada, España;2003.
16. Laporte Rosello E. Cholecystectomy by laparoscopy. Apropos 200 cases. Med Clin (Barc) 1992;98:734-737.
17. Abu-Eshy SA, Moosa RA, Al-Rofaidi AA, et al. Proinflammatory cytokines in open versus laparoscopic cholecystectomy. Saudi Med J 2002;23:436-440.
18. Baker RC, Armstrong MA, Allen SJ, McBride WT. Role of the kidney in perioperative inflammatory responses. Br J Anaesth 2002;88:330-334.
19. Kotani N, Takahashi S, Sessler DI, et al. Volatile anesthetics augment expression of proinflammatory cytokines in rat alveolar macrophages during mechanical ventilation. Anesthesiology 1999;91:187-197.
20. Chang CK, Zdon MJ. Inflammatory response of interleukin-1ß and interleukin-6 in septic rats undergoing laparotomy and laparoscopy. Surg Laparosc Endosc Percutan Tech 2005;15:124-128.
21. Maass DL, White J, Horton JW. IL-1b and IL-6 act synergistically with TNF-a to alter cardiac contractile function after burn trauma. Shock 2002;18:360-366.
22. Chiu-Braga YY, Hayashi SY, Schafranski M, Messias-Reason IJ. Further evidence of inflammation in chronic rheumatic valve disease (CRVD): high levels of advanced oxidation protein products (AOPP) and high sensitive C-reactive protein (hs-CRP). Int J Cardiol 2006;109:275-276.
23. Lannergard A, Hersio K, Larsson A, et al. Evaluation of laboratory markers for the detection of infections in open-heart surgery patients. Scand J Infect Dis 2003;35:121-126.
24. Kevin LG, Novalija E, Stowe DF. Reactive oxygen species as mediators of cardiac injury and protection: the relevance to anesthesia practice. Anesth Analg 2005;101:1275-1287.
25. Urena R, Mendez F, Ruiz-Deya G, Baratta A, Thomas R, Sikka S. Does prolonged pneumoperitoneum affect oxidative stress compared with open surgical procedures? J Endourol 2005;19:221-224.
26. Sivaci R, Orman A, Yilmazer M, Yilmaz S, Ellidokuz H, Polat C. The effect of low-flow sevoflurane and desflurane on pulmonary mechanics during laparoscopic surgery. J Laparoendosc Adv Surg Tech A 2005;15: 125-129.
27. Koksal GM, Sayilgan C, Aydin S, Uzun H, Oz H. The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy. Eur J Anaesthesiol 2004;21:217-220.
28. Sato N, Kawamoto M, Yuge O, et al. Effects of pneumoperitoneum on cardiac autonomic nervous activity evaluated by heart rate variability analysis during sevoflurane, isoflurane, or propofol anesthesia. Surg Endosc 2000;14:362-366.