Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1016/j.bjane.2014.07.008
Brazilian Journal of Anesthesiology
Scientific Article

Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia - a randomized study

Artroplastia total do joelho induz apoptose em linfócitos de sangue periférico e não é evitada por anestesia regional - Estudo randomizado

Juliusz Kosel; Malgorzata Rusak; Lukasz Golembiewski; Milena Dabrowska; Andrzej Siemiatkowski

http://dx.doi.org/10.1016/j.bjane.2014.07.008 Braz J Anesthesiol, vol.66, n2, p.133-139, 2016
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Abstract

ABSTRACT BACKGROUND: Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. METHODS: 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. RESULTS: Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. CONCLUSION: Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique.

Keywords

Total knee replacement, Regional anesthesia, General anesthesia, Lymphocytes, Apoptosis

Resumo

RESUMO JUSTIFICATIVA E OBJETIVO: Dentre as muitas alterações causadas por uma ferida cirúrgica, uma das menos estudadas é a imunossupressão pós-operatória. Esse fenômeno é uma causa importante das complicações infecciosas relacionadas à cirurgia, como infecção do sítio cirúrgico ou pneumonia nosocomial. Um dos mecanismos que levam à imunossupressão pós-operatória é a apoptose de células imunológicas. Durante a cirurgia, a anestesia se destina a minimizar as alterações prejudiciais e manter a homeostase perioperatória. O objetivo deste estudo foi avaliar o efeito da técnica anestésica usada para artroplastia total de joelho sobre a apoptose em linfócitos de sangue periférico no pós-operatório. MÉTODOS: Trinta e quatro pacientes submetidos à artroplastia total primária de joelho foram randomicamente designados para dois protocolos de anestesia regional: raquianestesia e bloqueio combinado raqui-peridural. Onze pacientes submetidos à artroplastia total do joelho sob anestesia geral formaram o grupo controle. Antes da cirurgia, logo após a cirurgia, durante o primeiro dia de pós-operatório e sete dias após a cirurgia, amostras de sangue venoso foram colhidas e o estado imunológico do paciente foi avaliado com o uso deflow cysts 87 m, juntamente com apoptose de linfócitos com o uso de microscopia de fluorescência. RESULTADOS: Apoptose em linfócitos de sangue periférico foi observada imediatamente no pós-operatório e acompanhada por uma redução do número de células T e B. Não houve diferença significativa no número de linfócitos apoptóticos de acordo com o protocolo anestésico. Alterações no número de células T CD3/8 e no número de linfócitos apoptóticos foram observadas no sétimo dia após a cirurgia. CONCLUSÃO: Apoptose em linfócitos de sangue periférico é um evento precoce no período pós-operatório que dura até sete dias e não é afetado pela escolha da técnica anestésica.

Palavras-chave

Artroplastia total do joelho, Anestesia regional, Anestesia geral, Linfócitos, Apoptose

References

Kirov SM, Shepherd JJ, Donald KD. Intraoperative and postoperative changes in peripheral white blood cell counts the contribution of stress. Aust N Z J Surg. 1979;49:738-42.

Kerr JF, Wyllie AH, Currie AR. Apoptosis a basic biological phenomenon with wide-ranging implications in tissue kinetics. Br J Cancer. 1972;26:239-57.

Elmore S. Apoptosis a review of programmed cell death. Toxicol Pathol. 2007;35:495-516.

Delogu G, Moretti S, Antonucci A. Apoptosis and surgical trauma dysregulated expression of death and survival factors on peripheral lymphocytes. Arch Surg. 2000;135:1141-7.

Osman ES, Khafagy HF, Samhan YM. In vivo effects of different anesthetic agents on apoptosis. Korean J Anesthesiol. 2012;63:18-24.

Werdehausen R, Fazeli S, Braun S. Apoptosis induction by different local anesthetics in a neuroblastoma cell line. Br J Anesth. 2009;103:711-8.

Papadima A, Boutsikou M, Lagoudianakis EE. Lymphocyte apoptosis after major abdominal surgery is not influenced by anesthetic technique a comparative study of general anesthesia versus combined general and epidural analgesia. J Clin Anesth. 2009;21:414-21.

Papadima A, Boutsikou M, Lagoudianakis EE. Anesthetic technique for radical prostatectomy surgery affects cancer recurrence a retrospective analysis. Anesthesiology. 2008;109:180-7.

Wuethrich PY, Hsu Schmitz SF, Kessler TM. Potential influence of the anesthetic technique used during open radical prostatectomy on prostate cancer-related outcome a retrospective study. Anesthesiology. 2010;113:570-6.

Tsui BC, Rashiq S, Schopflocher D. Epidural anesthesia and cancer recurrence rates after radical prostatectomy. Can J Anesth. 2010;57:107-12.

Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis. Anesthesiology. 2006;105:660-4.

Zasady . profilaktyki zylnej choroby zakrzepowo-zatorowej w ortopedii i traumatologii narzadu? ruchu. Ortop Traumatol Rehabil. 2009;11:86-92.

Martin D, Lenardo M. Morphological, biochemical, and flow cytometric assays of apoptosis. Curr Protoc Mol Biol. 2001.

Salo M. Effects of anesthesia and surgery on the immune response. Acta Anesthesiol Scand. 1992;36:201-20.

Bartal I, Melamed R, Greenfeld K. Immune perturbations in patients along the perioperative period alterations in cell surface markers and leukocyte subtypes before and after surgery. Brain Behav Immun. 2010;24:376-86.

Yadav K, Zehtabchi S, Nemes PC. Early immunologic responses to trauma in the emergency department patients with major injuries. Resuscitation. 2009;80:83-8.

Anderson JM, McNally AK. Biocompatibility of implants lymphocyte/macrophage interactions. Semin Immunopathol. 2011;33:221-33.

Ng CS, Lee TW, Wan S. Thoracotomy is associated with significantly more profound suppression in lymphocytes and natural killer cells than video-assisted thoracic surgery following major lung resections for cancer. J Invest Surg. 2005;18:81-8.

Wang ZY, Wang CQ, Yang JJ. Which has the least immunity depression during postoperative analgesia-morphine, tramadol, or tramadol with lornoxicam. Clin Chim Acta. 2006;369:40-5.

Conrick-Martin I, Kell MR, Buggy DJ. Meta-analysis of the effect of central neuraxial regional anesthesia compared with general anesthesia on postoperative natural killer T lymphocyte function. J Clin Anesth. 2012;24:3-7.

Yamada R, Tsuchida S, Hara Y, Tagawa M, Ogawa R. Apoptotic lymphocytes induced by surgical trauma in dogs. J Anesth. 2002;16:131-7.

Pehlivanoglu B, Bayrak S, Gurel EI, Balkanci ZD. Effect of gender and menstrual cycle on immune system response to acute mental stress apoptosis as a mediator. Neuroimmunomodulation. 2012;19:25-32.

Pires J, Curi R, Otton R. Induction of apoptosis in rat lymphocytes by starvation. Clin Sci. 2007;112:59-67.

Granchi D, Ciapetti G, Filippini F. Modulation of pro and anti-apoptotic genes in lymphocytes exposed to bone cements. J Biomater Sci Polym Ed. 2000;11:633-46.

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