Immunomodulation: TIVA versus VIMA

Waly, Salwa H.; Baqi, Hossam Abdel; Nasr, Yasser M.; Alazizi, Nashwa M.A.; Atfy, Maha

doi:10.1016/j.egja.2011.07.003

Immunomodulation: TIVA versus VIMA

Authors

10.1016/j.egja.2011.07.003

Abstract

Background
Different anesthetic techniques may have different effects on the immune response of patients undergoing the same type of surgery. The aim of the work is to evaluate the effects of two anesthetic techniques: total intravenous anesthesia (TIVA) with propofol versus volatile induction and maintenance anesthesia (VIMA) with sevoflurane, on cellular immune functions in patients undergoing meniscectomy.
Patients and methods
50 Adult patients scheduled for meniscectomy were randomly assigned into two groups: TIVA group (Group T: = 25), and VIMA group (Group V: = 25). A blood sample was collected 24 h before surgery (Sbasal). The first sample on the day of operation was collected just before the induction of anesthesia (S1), then 3 h later after induction (S2), and lastly 24 h after surgery (S3). CRP levels were assayed and T-lymphocyte subpopulations were investigated by flow-cytometry.
Results
CRP was increased at (S1) and reached its maximum levels at (S3) in both groups. CRP levels at (S3) were significantly higher in TIVA compared to VIMA groups. A significant decrease in the percentage of CD3, CD4 and decreased CD4/CD8 ratio occurred at (S2) and (S3) in both groups but more significantly with TIVA. CD8 showed no significant changes in both groups. NK cells decreased significantly at (S2) and (S3) in both groups, with no significant differences between the two groups. The percentage of HLA-DR showed no significant changes all through the study time in both groups.
Conclusion
VIMA with sevoflurane is less immunosuppressive than TIVA with propofol in patients undergoing minor surgery.

Keywords