Authors: Volkov O.О.
Introduction. The great number of works confirms a working hypothesis, that neuroinflammation has impact on development of the postoperative cognitive dysfunctions. The surgery duration and anaesthesia duration influence the postoperative cognitive dysfunctions was proven on animal models. This effect correlates with the changes of proinflammatory cytokines.
The goal of this study was to investigate influence of the anesthetic technique (inhalation versus total intravenous anaesthesia) for cesarean section on parturients’ plasma levels of proinflammatory (IL-6 and TNF-alpha) and antiinflammatory (IL-10) cytokines after surgery.
Materials and methods
Having agreed with local ethics committee and obtained informed consent, 64 pregnants (at 37-42 weeks gestation, who delivered by the caesarian section) were examined. The women were divided into two groups depending on maintenance of anaesthesia. For 1st group (n=30) was prescripted inhalation anaesthesia (IA). 2nd group (n=34) received total intravenous anaesthesia (TIVA). Criteria of exception were: age to 18 and 45 more than, term of pregnancy to 36 weeks, severe preeclamsia or eclampsia, decompensated extragenital pathology, diabetes mellitus, psychical diseases, signs of bacterial or viral infection, mycoses, abandonment of woman from participating in the research at any of it stages, use ketamine in an anaesthetic manual. Inhalation anaesthesia: induction - thiopental sodium (5 mgs/kg), maintenance - sevofluran 1,3 vol.%, in fresh gas flow 1,5 L/min. Relaxation – suxcinilcholinum (1-1,5 mgs/ kg). There were phentanyl (0,05 mgs/of ml - 4 mls) and diazepamum (10 mgs) after newborn extraction. Maintenance of analgesia is a phentanyl in a dose 0,05 mgs/of ml is a 1 ml having approaching of BIS by 60. ТIVА: induction - thiopental sodium (4 mgs/of kg), relaxation - suxcinilcholinum (1-1,5 mgs/of kg). Anaesthesia controlled by BISX Module, BIS™ Covidient, USA in both groups. The cytokines concentration was determined by the method of IFA analysis. We used on the kits of reagents JSC "Vector-Best" А- 8756 for TNFα with the range of measureable concentrations: 0-250 pg/ml. For IL - 6 was used on the kit of reagents Human IL-6 ELISA kit Diaclone (France) with the range of measureable concentrations: 0-200 pg/ml. The blood samples for analyses were taken: upon admission to the obstetrical department (P1), 24hours after the surgery (P2), on the 5-7th day after the surgery (P3).
Parameters of regional norm for IL-6 and TNFα were measured for 15 unpregnant healthy women in age 25-40. The blood samples for analyses were taken on an empty stomach at 9-11 a.m. The Normal val-ue for IL-6 was 1,40±0,15 pg/ml (range 0,92-1,67 pg/ml, σ=0,34). For TNFα a level of normal values was 9,37±1,07 pg/ml (range 4,50-12,7 pg/ml, σ=3,17).
Results and Discussion.
The study shows that the features of cytokine profile of pregnant at 37-42 weeks gestation are conditioned by the reliable increasing of levels both IL-6 and IL-10, but IL-6 level significantly dominates. However level of proinflammatory TNFα is reliable decreased. The cytokine profile after a caesarian section for pregnant at 37-42 weeks gestation is reliable correlated to the anesthetic technique.
After inhalation anaesthesia with sevofluran, as well as at TIVA level of proinflammatory IL-6 has a pike rising in 24 postoperative hours, with a progressive decreasing by 5-7 day after surgery. Moreover IL-6 increasing in 24 hours after cesarean section at TIVA is more expressed and one decreasing by 5-7 day considerably less than at inhalation anaesthesia. In addition inhalation anaesthesia does not influence on the level of proinflammatory TNFα after surgery, while TIVA keep on decreasing initially low level of TNFα. TIVA does not influence the level of antiinflammatory IL-10 in a postoperative period, while after inhalation anaesthesia it normalization starts already from the first day after cesarean section.
As a result inhalation anaesthesia assists to cytokine profile normalization by 5-7 day after caesarean section.
Keywords: sevofluran, general anaesthesia, caesarian section, cytokines.