The immunosuppressive effects of volatile versus intravenous anesthesia combined with epidural analgesia on kidney cancer: A pilot randomized controlled trial

Sergey Mihailovich Efremov, Victoria Sergeevna Kozireva, Gleb Borisovich Moroz, Marat Nikolaevich Abubakirov, Olga Sergeevna Shkoda, Anna Nikolaevna Shilova, Sergey Valeriyevich Yarmoshuk, Alexandr Alexandrovich Zheravin, Giovanni Landoni, Vladimir Vladimirovich Lomivorotov

Research output: Contribution to journalArticlepeer-review

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 anes-thetic) or sevoflurane-based (volatile anesthetic) anesthesia group with 10 patients in each group, along with epidural analgesia in both groups. Amounts of natural killer (NK) 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 NK cell count served as the primary endpoint of the study, whereas the total T lymphocyte count and cell counts for T lympho-cyte 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.

Original languageEnglish
Pages (from-to)525-533
Number of pages9
JournalKorean journal of anesthesiology
Volume73
Issue number6
DOIs
Publication statusPublished - Dec 2020

Keywords

  • Anesthesia
  • Cancer
  • Epidural analgesia
  • Immunity
  • Propofol
  • Sevoflurane

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