Korean J Anesthesiol.
2020 Dec;73(6):525-533. 10.4097/kja.19461.
The immunosuppressive effects of volatile versus intravenous anesthesia combined with epidural analgesia on kidney cancer: a pilot randomized controlled trial
- Efremov SM
1 - Kozireva VS2
- Moroz GB2
- Abubakirov MN2
- Shkoda OS3
- Shilova AN3
- Yarmoshuk SV4
- Zheravin AA4
- Landoni G5
- Lomivorotov VV2,6
- Affiliations
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- 1Department of Anesthesiology and Intensive Care, Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
- 2Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
- 3Department of Laboratory Diagnostics, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
- 4Department of Oncology, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
- 5Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
- 6Department of Anesthesiology and Intensive Care, Novosibirsk State University, Novosibirsk, Russian Federation
- KMID: 2510866
- DOI: http://doi.org/10.4097/kja.19461
Abstract
- 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 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 natural killer (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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