MISC

2005年11月

The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy

ANESTHESIA AND ANALGESIA
  • M Yokoyama
  • ,
  • Y Itano
  • ,
  • H Katayama
  • ,
  • H Morimatsu
  • ,
  • Y Takeda
  • ,
  • T Takahashi
  • ,
  • O Nagano
  • ,
  • K Morita

101
5
開始ページ
1521
終了ページ
1527
記述言語
英語
掲載種別
DOI
10.1213/01.ANE.0000184287.15086.1E
出版者・発行元
LIPPINCOTT WILLIAMS & WILKINS

We investigated whether perioperative extensive epidural block (C3-L) affects postoperative immune response in patients undergoing radical esophagectomy. Patients undergoing radical esophagectomy were randomly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia (group E, n = 15) or intraoperative general anesthesia and postoperative IV morphine analgesia (group G, n = 15). Plasma levels of stress hormones, cytokines, C-reactive protein (CRP), leukocyte counts, and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days (PODs) 1 and 3. In comparison with group E, significant increases in plasma epinephrine level at the end of surgery (P < 0.05) and norepinephrine level at the end of surgery (P < 0.01) and on POD1 (P < 0.01) and POD3 (P < 0.01) and significant decrease in cluster of differentiation (CD4/CD8 ratio) at the end of surgery (P < 0.05) were observed in group G. However, there were no significant differences in other variables between groups. In both groups, plasma cortisol, adrenocorticotropic hormone, interleukin (IL)-1 beta, IL-6, IL-10, and CRP levels were increased after surgery (each group P < 0.01) and IL-1 beta, IL-6, IL-10, and CRP were still increased on POD1 and POD3 (each change, each group P < 0.01). Leukocyte counts were increased on PODI (each group P < 0.05) and POD3 (each group P < 0.01). The proportion of lymphocytes decreased from the end of surgery to POD3 (each group P < 0.01). The proportion of B cells was increased on POD1 (each group P < 0.01); that of natural killer cells was decreased at PODI and POD3 (each group P < 0.01). We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy.

Web of Science ® 被引用回数 : 65

リンク情報
DOI
https://doi.org/10.1213/01.ANE.0000184287.15086.1E
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000232782800048&DestApp=WOS_CPL

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