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BJA Advance Access originally published online on February 27, 2008
British Journal of Anaesthesia 2008 100(4):478-484; doi:10.1093/bja/aen015
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormones

J. A. Kolsen-Petersen1,*, K. Bendtzen2 and E. Tonnesen1

1 Department of Anaesthesia and Intensive Care, Hospital of Aarhus, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
2 Institute for Inflammation Research IIR 7521, Rigshospitalet University Hospital, University of Copenhagen, Denmark

* Corresponding author. E-mail: jaakp{at}dadlnet.dk

Background: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery.

Methods: Sixty-two women undergoing abdominal hysterectomy were randomized in a double-blind study to infusion of NaCl 7.5% (HS), NaCl 0.9% (NS4), both 4 ml kg–1, or NaCl 0.9% 32 ml kg–1 (NS32) over 20 min. Blood was collected at baseline, 1, 4, and 24 h after surgery (n=34) for the determination of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, IL-1ra, and tumour necrosis factor-{alpha}. Serum cortisol and vasopressin were measured at these time points and 48 h after operation. Epinephrine and norepinephrine (n=26) were quantified at baseline, after infusion, 25 min after incision, 1, and 4 h after surgery. Finally, C-reactive protein was measured at baseline, 24, and 48 h after surgery.

Results: Surgery and anaesthesia induced well-reported changes in the concentrations of cytokines and hormones. The concentration of norepinephrine briefly increased after infusion of HS and NS32 but not NS4 (P<0.05). Epinephrine was increased 25 min after incision in Group NS32 compared with the other groups (P<0.05). No other differences were found between the groups.

Conclusions: Infusion of a clinically relevant dose of hypertonic saline before hysterectomy appears to have limited effect on the postoperative concentration of selected plasma cytokines and the hormonal stress-response.

Keywords: clinical trials; fluids, i.v.; hormones, adrenal; stress; surgery, laparotomy


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