Comparison of the Effects of Propofol Anaesthesia and Desflurane Anaesthesia on Neutrophil/Lymphocyte Ratios After Coronary Artery Bypass Surgery

Abstract

Objective: Coronary artery bypass surgery with cardiopulmonary bypass can induce postoperative systemic leukocytic alterations including leukocytosis, neutrophilia, or lymphopenia. The present study aims to compare the effects of propofol and desflurane anaesthesia on the leukocytic alterations including neutrophil-to-lymphocyte ratios after coronary artery bypass surgery.

Materials and Methods: Sixty patients scheduled for coronary artery bypass surgery were randomly assigned into two groups: group P (n=30), which were anaesthesised with propofol (intravenous anaesthesia) and group D, which were anaesthesised with desflurane (inhalational anesthesia). Differential counts of leukocytes with neutrophil/lymphocyte ratios of peripheral blood were obtained just before anaesthesia induction (for basal values), at the postoperative 12th, 24th, and 48th hours.

Results: At the postoperative 12th decrease in lymphocyte counts in group P was significantly lower than in group D (1.23 ± 0.81, 0.92 ± 1.01, respectively, with a p value of <0.001). Depending on this difference, neutrophil/lymphocyte ratios in group P were lower than in group D, which was statistically significant (11.21 ± 5.01, 22.81 ± 15.24, respectively, with a p value of <0.001). At postoperative 48th hour, it was seen that the statistically significant difference between groups on the basis of lymphocyte counts and neutrophil/lymphocyte ratios dissapeared. But a statistically significant difference appeared between the two groups on the basis of neutrophil counts (in group P 6.57 ± 2.05, in group D 10.20 ± 5.26; p<0.001)

Conclusion: Comparing with desflurane anaesthesia, propofol anaesthesia favorably but transiently modifies leukocytic alterations, including neutrophil-to-lymphocyte ratios in peripheral blood during postoperative period of coronary artery bypass surgery.

Key Words: Coronary Artery Surgery; Propofol And Desflurane Anesthesia; Neutrophil/Lymphocyte Ratio.

Keywords

• -

Journal of Turgut Ozal Medical Center

Abstract

Amaç: Kardiyopulmoner by-pass ile yapılan koroner arter by-pass cerrahisi lökositoz, nötrofili ve lenfopeniyi de içeren postoperatif lökosit dağılımı değişikliklerini başlatabilir. Bu çalışma ile kardiyopulmoner bypass kullanılarak koroner by-pass cerrahisine giden hastalarda propofol (intravenöz) ve desfluran (inhalasyon) anestezisinin postoperatif lökositik değişiklikler ve nötrofil/ lenfosit oranı üzerine etkileri incelenmiştir.Gereç ve Yöntemler: Bu prospektif randomize çalışmada elektif koroner arter by-pass cerrahisi planlanan 60 hasta iki eşit gruba randomize edildi. olgulardan 30’unda (grup P, n=30) propofol (intravenöz) anestezi ve diğer 30’unda ise (grup D, n=30) desfluran (inhalasyon anestezisi kullanıldı. Hastalardan lökosit alt tipleri ve nötrofil/lenfosit oranı tayini için anestezi indüksiyonundan hemen önce (bazal değer), postoperatif 12. saat, 24. saat ve 48. saatlerde olmak üzere periferik venden kan örneği alındı. Bulgular: Postoperatif 12.saat kan sayımlarında lenfosit sayısındaki düşüş grup P’de grup D’ye göre daha az belirgin (sırasıyla 1.23 ± 0.81, 0.92 ± 1.01 ve p değeri

Keywords

• Koroner By-Pass Cerrahisi, Propofol Ve Desfluran Anestezisi, Nötrofil/Lenfosit Oranı

References

1. Iwase M, Kondo G, Watanabe H, Takaoka S, Uchida M, Ohashi M, et al. Regulation of Fas-mediated apoptosis in neutrophils after surgery-induced acute inflammation. J Surg Res 2006;134:114-23.
2. Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, et al. Suppression of cellular immunity by surgical stress. Surgery 2000;127:329-36.
3. Utley JR. The immune response and cardiopulmonary bypass. In: Gravlee GP, Davis RF, Utley JR, eds. Principles and Practice of Cardiopulmonary Bypass. Baltimore, Md: Williams & Wilkins; 1993;249-66.
4. Kirklin JK, Westaby S, Blackstone EH, et al. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 1983;86:845-57.
5. Helmy SA, Wahby MA, El-Nawaway M. The effect of anaesthesia and surgery on plasma cytokine production. Anaesthesia 1999;54:733-8.
6. Crozier TA, Müller JE, Quittkat D, Sydow M, Wuttke W, Kettler D. Effect on aesthesia on the cytokine responses to abdominal surgery. Br J Anaesth 1994;72:280-5.
7. Ke JJ, Zhan J, Feng XB, Wu Y, Rao Y, Wang YL. A comparison of the effect of total intravenous anaesthesia with propofol and remifentanil and inhalational anaesthesia with isoflurane on the release of pro-and anti-inflammatory cytokines in patients undergoing open cholecystectomy. Anaesth Intensive Care 2008;36:74-8.
8. Inada T, Yamanouchi Y, Jomura S, Sakamoto S, Takahashi M, Kambara T, et al. Effect of propofol and isoflurane anaesthesia on the immune response to surgery. Anaesthesia 2004;59:954-9.

9. Gibson PH, Croal BL, Cuthbertson BH, Small GR, IfezulikeAI, Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J 2007;154:995-1002.
10. Kim WH, Jin HS, Ko JS, Hahm TS, Lee SM, Cho HS, et al. The effect of anesthetic techniques on neutrophil-to-lymphocyte ratio after laparoscopy assisted vaginal hysterectomy. Acta Anaesthesiol Taiwan. 2011;83-7.
11. Celik IH, Demirel G, Sukhachev D, Erdeve O, Dilmen U.Neutrophil volume, conductivity and scatter parameters with effective modeling of molecular activity statistical program gives better results in neonatal sepsis. Int J Lab Hematol. 2013;35:82-7.
12. Takahashi J, Shono Y, Hirabayashi H, Kamimura M, Nakagawa H, Ebara S, et al. Usefulness of white blood cell differential for early diagnosis of surgical wound infection following spinal instrumentation surgery. Spine 2006;31:1020-5.
13. Leng S, Xue QL, Huang Y, Semba R, Chaves P, Bandeen-Roche K, et al. Total and differential white blood cell counts and their associations with circulating interleukin-6 levels in community-dwelling older women. J Gerontol A Biol Sci Med Sci 2005;60:195-9.
14. Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y, Fukushima M. The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 2007;73:215-20.
15. Pinto EM, Huppert FA, Morgan K, Mrc C, Brayne C. Neutrophil counts, monocyte counts and cardiovascular disease in the elderly. Exp Gerontol 2004;39:615-9.
16. S. R. Rosenberg, R.Kalhan, “Biomarkers in chronic obstructive pulmonary disease,” Translational Research, vol. 159, no. 4, 2012;228-37.
17. W. Q. Gan, S. F. P. Man, A. Senthilselvan, and D. D. Sin, “Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a metaanalysis,” Thorax, vol. 59, no. 7, 2004;574–80.
18. Schneemilch CE, Ittenson A, Ansorge S, Hachenberg T, Bank U. Effect of 2 anesthetic techniques on the postoperative proinflammatory and antiinflammatory cytokine response and cellular immune function to minor surgery. J Clin Anesth 2005;17:517-27.