The effect of anaesthesia and surgery on plasma cytokine production

Abstract

The aim of this study was to investigate cytokine production in response to anaesthesia [total intravenous anaesthesia (TIVA) with propofol, sufentanil and atracurium] and surgery (laparoscopic vs. open cholecystectomy). Forty adult patients, ASA I-II, undergoing elective laparoscopic (group 1) or open (group 2) cholecystectomy were studied. Venous blood samples for measurement of interleukin (IL)-1β, IL-2, IL-4, IL-6, tumour necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were taken before the induction of anaesthesia, pre-incisionaly, at the end of anaesthesia and surgery and 24-h postoperatively. Pre-incisionaly, in both groups, IL-1β, IL-4, IL-6, TNF-α and IFN-γ did not show a significant change, whereas IL-2 showed a significant decrease (p < 0.005 in group 1 and p < 0.001 in group 2) compared with pre-induction levels. By the end of anaesthesia and surgery, IL-1β, IL-2, IL-4, IL-6 and TNF-α showed a significant increase in group 2 (p < 0.005 for IL-1β, IL-2 and IL-4, and p < 0.05 for IL-6 and TNF-α); while in group 1, only IL-2 showed a significant increase (p < 0.01) and IFN-γ showed a significant decrease (p < 0.05) compared with pre-incisional levels. By 24-h postoperatively, IL-1β, IL-4, IL-6 and TNF-α had decreased significantly in group 2 (p < 0.005 for IL-4 and p < 0.05 for the others); whereas in group 1, IL-2 and IFN-γ showed a significant increase (p < 0.005) compared with the end of anaesthesia and surgery level. In conclusion, TIVA with propofol, sufentanil and atracurium does not seem to have a significant effect on IL-1β, IL-4, IL-6, TNF-α and IFN-γ release. IL-2 was the only cytokine to show a significant decrease due to the effect of anaesthesia alone in both groups. The cytokine response to open cholecystectomy stimulated both the pro-inflammatory (IL-1β, IL-6 and TNF-α) and the anti-inflammatory (IL-4) components, while this response was absent in laparoscopic cholecystectomy.