The effect of general or spinal anaesthesia on pro- and anti-inflammatory intracellular cytokines in patients undergoing appendicectomy using flowcytometric method

Background
Cytokines are glycoproteins which have important role in immunological changes that occur in perioperative period. The balance between pro- and anti-inflammatory cytokines controls the clinical course and outcome.
Objectives
Compare intracellular levels of pro- and anti-inflammatory cytokines with general or spinal anaesthesia.
Patients and methods
Forty patients ASA physical status I–II between 20 and 35 years old, 23 males and 17 females undergoing appendicectomy were included in this comparative prospective study. Patients were randomly allocated into two equal groups: Group G under general anaesthesia induced by thiopental 5 mg/kg, fentanyl 2 μg/kg. Tracheal intubation facilitated by 0.8 mg/kg rocuronium and the maintenance with isoflurane 1.5% plus rocuronium 0.15 mg/kg, Group S under spinal anaesthesia with hyperbaric bupivacaine 0.5% 3–4 ml. Arterial blood pressure, heart rate and oxygen saturation were measured pre, post-induction of anaesthesia, then every 15 min till the end of operation. Tumour Necrosis Factor-α, Interleukin-6 and Interleukin-10 levels were measured before induction of anaesthesia, at the end of surgery and 12 h postoperatively.
Results
The study recorded a significant increase in pro-inflammatory (TNFα and IL-6) and the anti-inflammatory (IL-10) cytokine levels at the end of surgery when compared with pre-anaesthetic level in both groups with more significant increase of IL-10 in spinal group than general group. At 12 h postoperatively, TNF-α returned to normal in both groups; IL-6 and IL-10 increased significantly in all patients of both groups with more significant increase in IL-10 level in spinal group than general group. These findings show that there is significant difference between spinal and general anaesthesia as regards to IL-10 which increased more in spinal group than general group at the end of surgery and 12 h postoperatively.
Conclusion
The inflammatory response to surgery was suppressed during spinal anaesthesia to a greater extent than during general anaesthesia.