EFFECTS OF DIFFERENT ANESTHETIC TECHNIQUES ON INFLAMMATORY CYTOKINES RESPONSE AND T -LYMPHOCYTE SUBSETS IN PATIENTS UNDERGOING LOWER ABDOMINAL SURGERY

Most studies demonstrated that the anesthetic and anesthesia methods influence the immune function temporarily and reversibly. The current study evaluates the effects of different anesthetic techniques on the balance of pro-inflammatory and ant-iinflammatory cytokines and cellular immune function in patients undergoing lower abdominal surgery. Methodology: The study enrolled 54 patients, ASA MI between 20-60 years old, both sexes, presenting for lower abdominal surgery. Patients were randomly allocated to 3 groups 18 patients each: Epidural group, Total Intravenous Anesthesia group (TIVA) and Sevoflurane group. Heart rate, arterial blood pressure, and oxygen saturation were measured pre-induction of anesthesia, 5 min post induction then every 5 min till the end of surgery. Venous samples for measurements of interleukin-6 (IL-6), tumor necrosis factor -[alpha] (TNF-α), IL-10 and cellular elements (T-lymphocyte subgroups CD4, CD8 and natural killer cells) ,were drawn prior to the start of anesthesia then after 2 hour and 24 hour after surgery. The cytokines and T-lymphocyte subpopulations were investigated by flow-cytometry.Results: The demographic characteristics and the hemodynamic parameters of the three groups were comparable. The IL-6 was significantly increased at 2 hour and 24 hour after surgery in all groups (p 0.001), but less in epidural group in comparison to sevoflurane and TIVA groups (p 0.05). TNF-α was significantly increased at 2 hour in all groups in comparison to pre-operative value (p 0.001), but less in epidural group than other groups (p 0.05). At 24 hour postoperative, TNF-a returned to pre-operative value in all groups (p 0.05), while IL-10 increased significantly in epidural group compared to sevoflurane and TIVA group (p 0.05). Lymphocyte subgroups CD4, CD4/CD8 ratio were significantly decreased at 2 hour and 24 hour after surgery in all groups (p 0.05), but the decrease is less in epidural group than sevoflurane and TIVA groups (p 0.05). No changes occurred in CD8 in all groups during the study period (p 0.05). NK cells decreased in all groups at 2 hour and 24 hour after surgery but the decrease is more significant in TIVA group in relation to sevoflurane and epidural groups (p 0.05). Conclusions: The study suggests that epidural anesthesia was associated with protective immune responses compared with sevoflourane and TIVA. In addition sevoflurane is less immunosuppressive than TIVA in patients for lower abdominal surgery.