Comparison of the effects of regional and general anesthesia on the immune system via cytokines in urooncologic surgery

Öz

Objectives: In this study, it was aimed to compare effects of general anesthesia and spinal anesthesia on the im­mune system via serum cytokines interleukine 2 (IL-2), interleukine 4 (IL4), interleukine 6 (IL-6) in urologic cancer patients. Methods: Forty-four, ASA physical status I–II patient, who were scheduled for urooncologic surgery with spinal or general anesthesia enrolled to the study. Demographic parameters, heart rate and mean blood pressure values were recorded. Venous blood samples were taken at pre­operative period and postoperatively 6th hours to deter­mine IL-2, IL-4 and IL-6 levels. Results: There was no statistical significance between groups among heart rate and mean blood pressure val­ues. There were no significant difference in preopera­tive IL-2, IL-4, IL-6 and postoperative IL-2, IL-4 levels between groups, however postoperative IL-6 levels were significantly increased in general anesthesia group com­pared with spinal anesthesia group (p

Anahtar Kelimeler

• Spinal anaesthesia, general anaesthesia, in­terleukin -2, interleukin-4, interleukin-6

Üroonkolojik cerrahide rejyonel ve genel anestezinin immün sistem üzerine etkilerinin serum sitokinleri aracılığı ile karşılaştırılması

Öz

Amaç: Bu çalışmada cerrahi geçiren ürolojik kanser has­talarında genel anestezi ve spinal anestezi yöntemlerinin immün sistem üzerine olan etkileri serum interlökin-2 (IL- 2), İnterlökin-4 (IL-4), İnterlökin-6 (IL-6) aracılığı ile karşı­laştırılması amaçlandı. Yöntemler: Çalışmaya üroonkolojik cerrahi geçirecek, ASA I-II, 18-60 yaş arasında spinal veya genel aneste­zi uygulanacak 44 hasta dahil edildi. Grupların kalp atım hızı, ortalama arteriyel basınç değerleri ve demografik özellikleri kaydedildi. Preoperatif ve postoperatif 6. saatte venöz kan örnekleri alınarak IL-2, IL-4 ve IL-6 düzeyleri tespit edildi. Bulgular: Gruplar arası kalp atım hızı ve ortalama arteri­yel basınç değerleri arasında anlamlı bir farklılığa rastlan­madı. Preoperatif IL-2, IL-4, IL-6 ve postoperatif IL-2, IL-4 seviyeleri arasında anlamlı fark bulunmazken, postopera­tif IL-6 seviyesi genel anestezi grubunda spinal anestezi grubuna göre anlamlı yüksek bulundu (p

Anahtar Kelimeler

• Spinal anestezi, genel anestezi, in­terlökin-2, interlökin-4, interlökin-6

Kaynakça

1. McClain CJ, Barve S, Deacıuc i, Kugelmas M, Hill D. Cytokines in alcoholic liver disease. Semin Liver Dis 1999;19:205-219.
2. Helmy SA, Wahby MAM, El Nawaway M. The effect of anaesthesia and surgery on plasma cytokine produc- tion. Anaesthesia 1999;54:773-778.
3. Kılıç R, Yaşar M.A, Avcı L, Demirel İ, Yaşar D. Alt batın cerrahisi olgularında genel anesteziye eklenen epidu- ral anestezinin plazma sitokinleri ve kortizol seviyele- rine etkisi. Fırat Tıp Dergisi 2005;10:59-63.
4. Kirkegaard-Nielsen H, Caldwell JE, Berry PD. Rap- id tracheal intubation withrocuronium: a probabil- ity approach to determining dose. Anesthesiology 1999;91:131-136.
5. Lam AM, Pavlin EG, Visco E, Taraday J. Rocuronium versus succinylcholine-atracurium for tracheal intuba- tion and maintenance relaxation during propofol anes- thesia. J Clin Anesth 2000;12:449-453.
6. Shimada M, Winchurch RA, Beloucif S, Robotham JL. Effect of anesthesia and surgery on plasma cytokine levels. J Crit Care 1993;8:109-116.
7. Kehlet H The stress response to surgery. Release mechanisms and the modifying effect of pain relief. Acta Chir Scand 1989;550 (suppl):22-28.
8. Naito Y, Tamai S, Shingu K, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesi- ology 1992;77:426-431.

9. Žura M, Kozmar A, Šakić K, Malenica B, Hrgovic Z. Effect of spinal and general anesthesia on serum con- centration of pro-inflammatory and anti-inflammatory cytokines. Immunobiology 2012;217:622-627.
10. Crozier TA, Muller JE, Quittkat D, Sydow M, Wuttke W, Kettler D. Effect of anaesthesia on the cyto- cine responses to abdominal surgery. Br J Anaesth 1994;72:280-285.
11. Wada H, Seki S, Takahashi T. et al. Combined spinal and general anesthesia attenuates liver metastasis by preserving T71/T72 cytokine balance. Anesthesiology 2007;106: 499-506.
12. Buyukkocak U, Caglayan O, Daphan C, Aydinuraz K, Saygun O, Agalar F. Similar effects of general and spinal anaesthesia on perioperative stress response in patients undergoing haemorrhoidectomy. Mediators Inflammation 2006;1:1-5.
13. Hİgevold HE, Lyberg T, Kähler H, Haug E, Reikerås O. Changes in plasma IL-1 beta, TNF-alpha and IL-6 after total hip replacement surgery in general or re- gional anaesthesia. Cytokine 2000;12:1156-159.
14. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia. Anesthesiology 1995;82:1474-1506.
15. Gordon NH, Scott DB, Perey RIW. Modification of plasmacorticosteroid concentrations during and after surgery by epidural blockade. Br Med J 1973;10:581- 583.
16. Kato M, Suzuki H, Murakami M, at al. Elevated plasma levels of IL-6, IL-8 and granulocyte colony-stimulating factor during and after major abdominal surgery. J Clin Anesth 1997;9:293-298