Propofol Increased the Interleukin-6 to Interleukin-10 Ratio more than Isoflurane after Surgery in Long-term Alcoholic Patients

Abstract

This study investigated the effect of an anaesthetic regimen on the immune response in 40 long-term alcoholic patients undergoing surgery. Patients were randomly allocated to receive either propofol or isoflurane during surgery. Plasma cytokines interleukin (IL)-6 and IL-10 were measured at defined times and rates of post-operative infections were documented. The IL-6/IL-10 ratio significantly increased with propofol compared with isoflurane on day 1 after surgery and the IL-10 level significantly increased with isoflurane on day 1 after surgery. The overall post-operative infection rate was significantly higher in isoflurane-treated patients. Our findings indicate that propofol anaesthesia might be the more favourable regimen, with the IL-6/IL-10 ratio indicating an attenuation of the immune imbalance after surgery in long-term alcoholic patients. These results support the undertaking of a properly powered clinical trial to determine if propofol anaesthesia can reduce the postoperative infection rate in this special patient population.

Keywords

Propofol Isoflurane Anaesthetics Surgery Long-term alcoholics Cytokine Infection

References

Tønnesen

Petersen

Hojgaard

: Postoperative morbidity among symptom-free alcohol misusers. Lancet 1992; 340: 334–337.

Tønnesen

: The alcohol patient and surgery. Alcohol Alcohol 1999; 34: 148–152.

Spies

Nordmann

Brummer

: Intensive care unit stay is prolonged in chronic alcoholic men following tumor resection of the upper digestive tract. Acta Anaesthesiol Scand 1996; 40: 649–656.

Spies

Neuner

Neumann

: Intercurrent complications in chronic alcoholic men admitted to the intensive care unit following trauma. Intensive Care Med 1996; 22: 286–293.

Tønnesen

Kehlet

: Preoperative alcoholism and postoperative morbidity. Br J Surg 1999; 86: 869–874.

Gilliland

Armstrong

Carabine

: The choice of anesthetic maintenance technique influences the anti-inflammatory cytokine response to abdominal surgery. Anesth Analg 1997; 85: 1394–1398.

Volk

Döpfmer

Schmutzler

: Stress induced IL-10 does not seem to be essential for early monocyte deactivation following cardiac surgery. Cytokine 2003; 24: 237–243.

Spies

Von Dossow

Eggers

: Altered cell-mediated immunity and increased postoperative infection rate in long-term alcoholic patients. Anesthesiology 2004; 100: 1088–1100.

Sander

Irwin

Sinha

: Suppression of interleukin-6 to interleukin-10 ratio in chronic alcoholics: Association with postoperative infections. Intensive Care Med 2002; 28: 285–292.

10.

Crozier

Muller

Quittkat

: Effect of anesthesia on the cytokine responses to abdominal surgery. Br J Anaesth 1994; 72: 280–285.

11.

Inada

Yamanouchi

Jomura

: Effect of propofol and isoflurane anesthesia on the immune response to surgery. Anaesthesia 2004; 59: 954–959.

12.

Salo

Pirttikangas

Pulkki

: Effects of propofol emulsion and thiopenthone on T helper cell type-1/type-2 balance in vitro Anesthesia 1997; 52: 341–344.

13.

Ewing

: Detecting alcoholism: The CAGE questionnaire. JAMA 1984; 252: 1905–1907.

14.

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th edn. Washington: American Psychiatric Association 2000.

15.

Halle

Göbel

Kastrup

: In: Check-up Anesthesiology ( Kox

Spies

, eds). Berlin: Springer 2003; Chapter B-10, pp 446–448.

16.

Knaus

Wagner

Draper

: The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619–1636.

17.

Garner

Jarvis

Emori

: CDC definitions for nosocomial infections. Am J Infect Control 1988; 16: 128–140.

18.

Chastre

Fagon

: Ventilator-associated pneumonia (review). Am J Respir Crit Care Med 2002; 165: 867–903.

19.

Levy

Fink

Marshall

: 2001 SCCM/ESCIM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250–1256.

20.

Mayo-Smith

: Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA 1997; 278: 144–151.

21.

Otter

Spies

: Treatment of alcohol withdrawal syndrome. Standard operating procedures. In: Check-up Anesthesiology ( Kox

Spies

, eds). Berlin: Springer 2003; chapter B-3.1, p 375.

22.

Spies

Otter

Huske

: Alcohol withdrawal severity is decreased by symptom-orientated adjusted bolus therapy in the ICU. Intensive Care Med 2003; 29: 2230–2238.

23.

Spies

Rommelspacher

: Alcohol withdrawal in the surgical patient: Prevention and treatment. Anesth Analg 1999; 88: 946–954.

24.

Brunner

Domhof

Langer

: Nonparametric Analysis of Longitudinal Data in Factorial Experiments. New York: Wiley 2002.

25.

Irwin

Miller

: Decreased natural killer cell responses and altered interleukin-6 and interleukin-10 production in alcoholism: An interaction between alcohol dependence and African – American ethnicity. Alcohol Exp Res 2000; 24: 560–569.

26.

Pirttikangas

Salo

Mansikka

: The influence of anesthetic technique upon the immune response to hysterectomy. Anaesthesia 1995; 50: 1056–1061.

27.

Sander

von Heymann

Neumann

: Increased interleukin-10 and cortisol in long-term alcoholics after cardiopulmonary bypass: A hint to the increased postoperative infection rate? Alcoholism Clin Exp Res 2005; 29: 1677–1684.

28.

Takaono

Yogosawa

Okawa-Takatsuji : Effects of intravenous anesthetics on interleukin (IL)-6 and IL-10 production by lipopolysaccaride-stimulated mononuclear cells from healthy volunteers. Acta Anaesthesiol Scand 2002; 46: 176–179.

29.

Munford

Pugin

: The crucial role of systemic responses in the innate (non-adaptive) host defense. Review. J Endotoxin Res 2001; 7: 327–332.

30.

Spies

Eggers

Szabo

: Intervention at the level of the neuroendocrine–immune axis and postoperative pneumonia rate in long-term alcoholics. Am J Respir Crit Care Med 2006; 174: 408–414.

31.

Heil

Spies

Bullmann

: The relevance of CDT (carbohydrate-deficient transferrin). Preoperative diagnosis of chronic alcohol abuse in intensive care patients following elective tumor resection. Anaesthetist 1994; 43: 447–453.

32.

Calvacanti

Valencia

Torres

: Respiratory nosocomial infections in the medical intensive care unit. Microbes Infect 2005; 7: 292–301.

33.

Nseir

Di Pompeo

Soubrier

: Outcomes of ventilated COPD patients with nosocomial tracheobronchitis: A case-control study. Infection 2004; 32: 210–216.