BJA Advance Access originally published online on January 11, 2007
British Journal of Anaesthesia 2007 98(2):196-203; doi:10.1093/bja/ael334
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Effects of epidural anaesthesia on surgical stress-induced immunosuppression during upper abdominal surgery
1 Department of Anaesthesiology
2 First Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
* Corresponding author: Department of Anaesthesiology, University of Occupational and Environmental Health, 1-1-1 Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan. E-mail: mogata{at}med.uoeh-u.ac.jp
BACKGROUND: Previously, we have demonstrated that surgical stress rapidly induced transient hyporesponsiveness of blood cells to endotoxin and that monocyte mCD14 and HLA-DR expression decreased soon after the start of surgery under general anaesthesia. This study was designed to investigate the effects of epidural anaesthesia on surgical stress-induced immunosuppression in patients undergoing upper abdominal surgery.
METHODS: After having obtained informed consent, patients were randomly allocated to receive general anaesthesia (Group G) or general anaesthesia with epidural anaesthesia (Group E). Perioperative changes in neutrophil phagocytic activity, neutrophil respiratory burst activity, monocyte mCD14 and HLA-DR expression, plasma IL-10 concentration, and the LPS-induced TNF-
production in whole blood were measured.
RESULTS: Surgical stress rapidly depressed neutrophil phagocytic activity, monocyte mCD14 and HLA-DR expression, and LPS-induced TNF- production ex vivo (P < 0.05 vs preoperation) in both Group G and Group E. In contrast, the plasma IL-10 concentration increased significantly 2 h after the start of surgery (P < 0.05) in both groups. There were no significant differences between the two groups. The neutrophil respiratory burst activity did not change during the operation in either group.
CONCLUSION: This study showed that the innate immune system is suppressed from the early period of upper abdominal surgery. Subgroup analysis suggested that epidural anaesthesia to T4 dermatome as well as general anaesthesia may not protect patients from this immunosuppression. These results in part explain the impairment of host-defense mechanisms seen in the perioperative period.
Keywords: anaesthesia, general; anaesthetic techniques, epidural; immune response, suppression; surgery, GI
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