TY - JOUR
T1 - Effects of surgery, general anesthesia, and perioperative epidural analgesia on the immune function of patients with non-small cell lung cancer
AU - Cata, Juan P.
AU - Bauer, Maria
AU - Sokari, Telemate
AU - Ramirez, María F.
AU - Mason, David
AU - Plautz, Gregory
AU - Kurz, Andrea
PY - 2013/6
Y1 - 2013/6
N2 - Study Objective To assess preoperative and postoperative immune function in patients undergoing surgical resection of non-small cell lung cancer during general anesthesia and postoperative epidural analgesia. Design Observational single-center study. Setting University-affiliated academic center. Patients 24 adult, ASA physical status 3 and 4 patients with stage 1, 2, or 3 non-small cell lung cancer. No study patient received preoperative chemotherapy or radiation. Interventions Patients underwent thoracotomy with general anesthesia and postoperative epidural analgesia. Measurements Bispectral index monitoring, sevoflurane requirements, and intraoperative transfusions were recorded. Total fentanyl consumption and pain (verbal numeric rating scale) were recorded 24 hours after surgery. Preoperative and 24-hour postoperative natural killer cell percentage and function and percentages of natural killer T cells, T helper cells (CD4 +), and cytotoxic T lymphocytes (CD8 +) were measured. Plasma concentrations of the TH1 cytokine interleukin-2 and interferon-gamma and the TH2 cytokines interleukin-4 were measured at the same time points. Results The percentage (preoperative, 13.07 ± 9.81% vs postoperative, 9.6 ± 6.57%, P < 0.001) and function (preoperative, 31.61 ± 21.96%; postoperative, 13.61 ± 9.36%; P < 0.001) of natural killer cells was significantly decreased after surgery, but the percentage of natural killer T cells, T helper cells (CD4 +), and cytotoxic T lymphocytes (CD8 +) remained unchanged postoperatively; thus, the CD4/CD8 ratio remained unchanged. Postoperative plasma concentrations of the three cytokines were similar to preoperative levels; therefore, the TH1/T H2 ratio also remained unchanged. Conclusions Innate immunity is depressed in patients with non-small cell lung cancer after surgical resection, and immunity is not preserved by the use of postoperative epidural analgesia.
AB - Study Objective To assess preoperative and postoperative immune function in patients undergoing surgical resection of non-small cell lung cancer during general anesthesia and postoperative epidural analgesia. Design Observational single-center study. Setting University-affiliated academic center. Patients 24 adult, ASA physical status 3 and 4 patients with stage 1, 2, or 3 non-small cell lung cancer. No study patient received preoperative chemotherapy or radiation. Interventions Patients underwent thoracotomy with general anesthesia and postoperative epidural analgesia. Measurements Bispectral index monitoring, sevoflurane requirements, and intraoperative transfusions were recorded. Total fentanyl consumption and pain (verbal numeric rating scale) were recorded 24 hours after surgery. Preoperative and 24-hour postoperative natural killer cell percentage and function and percentages of natural killer T cells, T helper cells (CD4 +), and cytotoxic T lymphocytes (CD8 +) were measured. Plasma concentrations of the TH1 cytokine interleukin-2 and interferon-gamma and the TH2 cytokines interleukin-4 were measured at the same time points. Results The percentage (preoperative, 13.07 ± 9.81% vs postoperative, 9.6 ± 6.57%, P < 0.001) and function (preoperative, 31.61 ± 21.96%; postoperative, 13.61 ± 9.36%; P < 0.001) of natural killer cells was significantly decreased after surgery, but the percentage of natural killer T cells, T helper cells (CD4 +), and cytotoxic T lymphocytes (CD8 +) remained unchanged postoperatively; thus, the CD4/CD8 ratio remained unchanged. Postoperative plasma concentrations of the three cytokines were similar to preoperative levels; therefore, the TH1/T H2 ratio also remained unchanged. Conclusions Innate immunity is depressed in patients with non-small cell lung cancer after surgical resection, and immunity is not preserved by the use of postoperative epidural analgesia.
KW - Analgesia, epidural
KW - Anesthesia
KW - Innate immunity
KW - Lung cancer
KW - Natural killers non-small cell lung cancer
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U2 - 10.1016/j.jclinane.2012.12.007
DO - 10.1016/j.jclinane.2012.12.007
M3 - Article
C2 - 23659826
AN - SCOPUS:84881089492
SN - 0952-8180
VL - 25
SP - 255
EP - 262
JO - Journal of Clinical Anesthesia
JF - Journal of Clinical Anesthesia
IS - 4
ER -