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KMID : 0356920200730060525
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Korean Journal of Anesthesiology
2020 Volume.73 No. 6 p.525 ~ p.533
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The immunosuppressive effects of volatile versus intravenous anesthesia combined with epidural analgesia on kidney cancer: a pilot randomized controlled trial
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Efremov Sergey Mihailovich
Kozireva Victoria Sergeevna
Moroz Gleb Borisovich
Abubakirov Marat Nikolaevich
Shkoda Olga Sergeevna
Shilova Anna Nikolaevna
Yarmoshuk Sergey Valeriyevich
Zheravin Alexandr Alexandrovich
Landoni Giovanni
Lomivorotov Vladimir Vladimirovich
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Abstract
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Background: The aim of this study was to test the hypothesis that the use of inhalational anesthesia leads to higher suppression of the cell-mediated immunity compared to total intravenous anesthesia in patients undergoing kidney cancer surgery under combined low thoracic epidural analgesia and general anesthesia.
Methods: Patients were randomly allocated to either propofol-based (intravenous anesthetic) or sevoflurane-based (volatile anesthetic) anesthesia group with 10 patients in each group, along with epidural analgesia in both groups. Amounts of natural killer (NK) cells, total T lymphocytes, and T lymphocyte subpopulations in the blood samples collected from the patients before surgery, at the end of the surgery and postoperative days 1, 3 and 7 were determined by flow cytometric analysis. The NK cell count served as the primary endpoint of the study, whereas the total T lymphocyte count and cell counts for T lymphocyte subpopulations were used as the secondary endpoint.
Results: Our study showed that there were no significant differences in the amount of NK cells, total T lymphocytes, regulatory T cells, and T-helper cells, cytotoxic T lymphocytes, and their subpopulations between the propofol- and sevoflurane-based anesthesia groups when the anesthesia was administered in combination with epidural analgesia.
Conclusions: The results of this pilot study did not support the hypothesis that the use of inhalational anesthesia leads to higher suppression of the cell-mediated immunity than that of total intravenous anesthesia in patients undergoing kidney cancer surgery under combined low thoracic epidural analgesia and general anesthesia.
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KEYWORD
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Anesthesia, Cancer, Epidural analgesia, Immunity, Propofol, Sevoflurane
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