Influence of anaesthesia and surgery on neutrophil chemotaxis

Early dynamic changes to monocytes following major surgery are associated with subsequent infections

Background

Post-operative infections are a common cause of morbidity following major surgery. Little is understood about how major surgery perturbs immune function leading to heightened risk of subsequent infection. Through analysis of paired blood samples obtained immediately before and 24 h following surgery, we evaluated changes in circulating immune cell phenotype and function across the first 24 h, to identify early immune changes associated with subsequent infection.

Methods

We conducted a prospective observational study of adult patients undergoing major elective gastrointestinal, gynecological, or maxillofacial surgery requiring planned admission to the post-anesthetic care unit. Patients were followed up to hospital discharge or death. Outcome data collected included mortality, length of stay, unplanned intensive care unit admission, and post-operative infections (using the standardized endpoints in perioperative medicine-core outcome measures for perioperative and anesthetic care criteria). Peripheral blood mononuclear cells were isolated prior to and 24 h following surgery from which cellular immune traits including activation and functional status were assessed by multi-parameter flow cytometry and serum immune analytes compared by enzyme-linked immunosorbent assay (ELISA).

Results

Forty-eight patients were recruited, 26 (54%) of whom developed a post-operative infection. We observed reduced baseline pre- and post-operative monocyte CXCR4 and CD80 expression (chemokine receptors and co-stimulation markers, respectively) in patients who subsequently developed an infection as well as a profound and selective post-operative increase in CD4+ lymphocyte IL-7 receptor expression in the infection group only. Higher post-operative monocyte count was significantly associated with the development of post-operative infection (false discovery rate < 1%; adjusted p-value = 0.001) with an area under the receiver operating characteristic curve of 0.84 (p < 0.0001).

Conclusion

Lower monocyte chemotaxis markers, higher post-operative circulating monocyte counts, and reduced co-stimulatory signals are associated with subsequent post-operative infections. Identifying the underlying mechanisms and therapeutics to reverse defects in immune cell function requires further exploration.

Effects of Propofol and Midazolam on the Inflammation of Lungs after Intravenous Endotoxin Administration in Rats

OBJECTIVE

Pulmonary complications are important sepsis (such as ARDS, diffuse pneumonia). Acute respiratory distress syndrome (ARDS) is characterized by the extensive migration of neutrophils into alveoli of the lungs. Propofol and midazolam are the most widely used agents for sedation in intensive care units. Aimed to investigate the effects of anaesthesia with propofol and midazolam on measured hemodynamic variables and neutrophil migration induced by Escherichia Coli endotoxin (ECE) in pulmonary viscera.

MATERIALS AND METHODS

Forty Sprague Dawley male rats were randomly assigned to four groups: Thiopental Sodium 30 mg/kg was administered intraperitoneally to anesthetize the rats. They were ventilated via tracheotomy. Femoral artery was cannulated for the measurement of continuous blood pressure and gases. Group C was the control. After the administration of 1 mL/kg 0.9% NaCL, infusion began at 1 mL/kg/h rate. In Group E 15 mg/kg lipopolysaccharide derived from ECE was administered iv. In Group PE, after a bolus dose of 10 mg/kg propofol and 15 mg/kg ECE, 10 mg/kg/h infusion was applied. In Group ME, after 0.1 mg/kg midazolam bolus dose and 15 mg/kg ECE administration, 0.1 mg/kg/h infusion was administered iv. Rats were sacrified by iv potassium chloride. The lungs were then removed, fixed in 10% buffered formalin for 3 days and embedded in paraffin. They were graded on a scale of 0-3 according to the aggregation of neutrophils.

RESULTS

There was intense neutrophil migration in Group E (grade 2, 3). However, although mild neutrophil migration was obtained in 70% of the rat lungs in Group ME (grade 1, 2), it was recorded in only 30% of Group PE (grade 1).

CONCLUSION

The sepsis model induced by ECE and compared with midazolam, propofol anaesthesia is associated with less neutrophil infiltration. In the light of the literature, propofol attenuate the free-radical-mediated lipid peroxidation and systemic inflammation in patients.

Perioperative reductions in circulating lymphocyte levels predict wound complications after excisional breast cancer surgery

OBJECTIVE

Postoperative wound complications after excisional surgery for primary breast cancer can result in patients requiring additional treatments and delay adjuvant therapy and are associated with worse prognoses.We investigated factors that might predispose patients to wound complications.

BACKGROUND

A number of patient characteristics have been associated with wound complications, but there is currently no quantitative measure of the risk of their occurrence. Our hypothesis was that wound complications are related, in part, to the immune status of patients.

METHODS

We recruited patients undergoing surgery for primary breast cancer and determined their circulating levels of various immune cells shortly before and after surgery as a measure of immune status.

RESULTS

One hundred seventeen patients were recruited; 16 (13.7%) developed wound complications. The following patient and tumor characteristics were associated with higher wound complication rates: diabetes (P = 0.02); larger tumors (T2/3 vs T1; P = 0.02); metastatic axillary nodes (P = 0.006). With respect to immune status, no significant differences in preoperative levels of circulating immune cells were detected between patients who developed wound complications and those who did not. However, patients who developed complications showed greater reductions in lymphocyte levels 4 hours postoperatively than those who did not (P <0.001). Multivariate analyses demonstrated that falls in lymphocyte levels of greater than 20% or 50% 4 hours postoperatively acted as a significant and independent predictor of wound complications (P < 0.005 and P < 0.0001,respectively).

CONCLUSIONS

Perioperative changes in lymphocyte levels could provide a practical predictive marker for wound complications on which selective antibiotic prophylaxis could be based.

Surgery induced immunosuppression

Surgery and anaesthesia result in a variety of metabolic and endocrine responses, which result in a generalised state of immunosuppression in the immediate post-operative period. Surgery induced immunosuppression has been implicated in the development of post-operative septic complications and tumour metastasis formation. In addition the effectiveness of many treatments in the adjuvant setting is dependent on a functioning immune system. By understanding the mechanisms contributing to surgery-induced immunosuppression, surgeons may undertake strategies to minimise its effect and reduce potential short-term and long-term consequences to patients.

The effects of anesthesia and surgery on count and function of neutrophils

The effects of anesthesia and surgery on neutrophil count, chemotaxis and neutrophil alkaline phosphatase (NAP) score were investigated in 10 patients who had elective spine surgery. Plasma levels of adrenaline, noradrenaline and cortisol were measured and correlations between hormonal levels and neutrophil count and function were assessed. Neutrophil count started increasing after the initiation of surgery, reached the highest level at 3 hours after surgery, and decreased gradually toward preanesthetic level on 3rd postoperative day. The increase in band cell: segment cell ratio is prominent, whereas lymphocytes decreased significantly. Neutrophil chemotaxis and spontaneous migration were increased significantly from the end of operation to 1st postoperative day. NAP score, assumed to reflect the neutrophil phagocytic activity, lowered transiently during anesthesia, then increased 1.6 times more than preanesthetic level on 1st postoperative day. It was indicated that the increased cortisol release rather than adrenaline due to body response to surgical stress might induce neutrophilia, and that the elective spine surgery might not be deleterious to the neutrophil function.

Models of focal cerebral ischemia in the nonhuman primate

Ischemic stroke is a uniquely human disease syndrome. Models of focal cerebral ischemia developed in nonhuman primates provide clinically relevant platforms for investigating pathophysiological alterations associated with ischemic brain injury, microvascular responses, treatment responses, and clinically relevant outcomes that may be appropriate for ischemic stroke patients. A considerable number of advantages attend the use of nonhuman primate models in cerebral vascular research. Appropriate development of such models requires neurosurgical expertise to produce single or multiple vascular occlusions. A number of experimentally and clinically accessible outcomes can be measured, including neurological deficits, neuron injury, evidence of non-neuronal cell injury, infarction volume, real-time imaging of injury development, vascular responses, regional cerebral blood flow, microvascular events, the relation between neuron and vascular events, and behavioral outcomes. Nonhuman primate models of focal cerebral ischemia provide excellent opportunities for understanding the vascular and cellular pathophysiology of cerebral ischemic injury, which resembles human ischemic stroke, and the appropriate study of pharmacological interventions in a human relevant setting.

[Anesthesia in the HIV positive or AIDS patient]

OBJECTIVE

To analyze the current anaesthetic management of HIV/AIDS patients.

DATA SOURCES

References were obtained from computerized bibliographic research (Medline), recent review articles, the library of the service, personal files.

STUDY SELECTION

Original articles, reviews, cases reports, letters to the editor in French and English were analyzed and selected.

DATA EXTRACTION

Current data on HIV infection, perioperative clinical and biological symptoms, arguments for choice of the type of anaesthesia, risks of transmitting HIV to health care workers and protective measures were extracted.

DATA SYNTHESIS

Twenty per cent of HIV-positive patients require surgery during their illness. Anaesthesia and surgery decrease cell mediated immunity and modify the activity of immune mediators. These changes are more pronounced under general anaesthesia compared to regional anaesthesia. They are transient and not clinically significant. Poor information is available concerning the perioperative management of HIV-positive patients and the effects of anesthesia on their immune status. Preoperative evaluation focuses on the following three important data: patient's status, surgery, and anaesthesia. In patients in good clinical conditions who comply with treatment, the anesthetist assesses the effects of the antiretroviral treatment and the risk of interactions between anaesthetic and antiretroviral agents. Etomidate, atracurium, cisatracurium, remifentanil and desflurane are not dependent on hepatic metabolism by the cytochrome P450 system. In patients in bad clinical conditions or in patients who do not comply with treatment, attention focuses on cardiovascular, pulmonary, neurologic and nutritional status. The specific antiretroviral treatment is not discontinued in the perioperative period, as far as compatible with the type of surgery and associated dysfunction of the digestive tract. Regional anaesthesia offers the benefits of not interfering with the immune system and antiretroviral agents. However, the viral infection can be enhanced by regional anaesthesia due to the cofactors' effect of local anaesthetic agents in cerebrospinal fluid. Homologous blood transfusion is not recommended as it increases postoperative infection and viral activation. Erythropoietin can be of benefit in selected cases. In the future, supportive immunotherapy will probably be the main tool for perioperative management of HIV and AIDS patients.

The inhibitory effects of thiopental, midazolam, and ketamine on human neutrophil functions

We investigated the effect of thiopental, midazolam, and ketamine (at clinically relevant concentrations and at 0.1 and 10 times these concentrations) on several aspects of human neutrophil functions. The three intravenous (i.v.) anesthetics significantly decreased chemotaxis, phagocytosis, and reactive oxygen species (ROS) (O2-, H2O2, OH) production of neutrophils in a dose-dependent manner. At clinically relevant concentrations, thiopental and midazolam significantly depressed these neutrophil functions. However, ketamine at the clinical plasma concentration did not impair chemotaxis or ROS production, except phagocytosis. In contrast, the three anesthetics had no effect on the levels of ROS production by a cell-free ROS generating system. In addition, intracellular calcium concentrations in neutrophils stimulated by N-formyl-L-methionyl-L-leucil-L-phenylalanine were dose-dependently decreased in the presence of each of the three anesthetics. The suppression of an increase in intracellular calcium concentrations may be responsible for the inhibition of neutrophil functions by the i.v. anesthetics.

IMPLICATIONS

Neutrophils play an important role in the antibacterial host defense system and autotissue injury. We found that thiopental and midazolam (but not ketamine), at clinically relevant concentrations, impaired the neutrophil functions.

DNA scission after focal brain ischemia. Temporal differences in two species

BACKGROUND AND PURPOSE

Species- and model-dependent differences in cell response to focal brain ischemia may underlie differences in adhesion receptor expression. The aim of this study was to quantitatively evaluate the spatial and temporal distribution of dUTP incorporation into damaged DNA, as an indicator of ischemic injury, in the corpus striatum.

METHODS

Cerebral ischemia was produced in 16 nonhuman primates and 19 rats by occluding the middle cerebral artery (MCA:O) with reperfusion for various periods. In situ dUTP was incorporated into cells with DNA damage by terminal deoxynucleotidyl transferase (TdT), DNA polymerase I, or the Klenow fragment of DNA polymerase. Dual immunolabeling experiments with immunoprobes against neuronal, vascular, or glial marker proteins were performed.

RESULTS

Significant topographical differences in dUTP between the two species were seen. In both models the TdT and polymerase I regions changed characteristically during focal ischemia. The number and density of dUTP-labeled cells increased with time from MCA:O and were dramatically different between the species (2P < .001). By 2 hours of ischemia, the density of dUTP label was 48.8 +/- 10.3 cells/mm2 in the primate and 2.4 +/- 0.8 cells/mm2 in the rat (2P < .05), but these values became nearly identical by 24 hours of reperfusion. In the primate, 80.0 +/- 6.6% of labeled cells displayed microtubule-associated protein-2 antigen (at 2-hour MCA:O), while 1.8 +/- 0.5% were associated with microvessels at 24 hours of reperfusion.

CONCLUSIONS

In situ detection of DNA damage, accomplished by three methods, reveals distinct temporal, topographical, and density differences in ischemic injury to cells in the primate and the rat corpus striatum as a result of MCA:O.

Halothane and isoflurane enhance melanoma tumour metastasis in mice

PURPOSE

To investigate the incidence of tumour metastasis from B16 melanoma tumour cells in experimental animals following exposure to equipotent concentrations of halothane or isoflurane, and to differentiate if exposure to one anaesthetic resulted in greater metastases than the other.

METHODS

Experimental animals (C57B1 mice), were randomized to receive 1.3 MAC hours of halothane or isoflurane anaesthesia. The control group of animals received oxygen alone under identical conditions. Fifteen minutes after completion of anaesthesia, control and experimental groups were given 1 x 10(5) B16 melanoma cells intravenously. After 21 days, all animals were autopsied, and the metastatic nodules in their lungs were counted. The difference in the numbers of metastatic nodules between control and experimental groups of animals was analyzed for significance by the Mann Whitney "U test".

RESULTS

More metastases were observed in the animals exposed to halothane (37.28 +/- 5.08, P < 0.0001), or isoflurane anaesthesia (28.24 +/- 4.07, P < 0.0014) than in the control animals (12.22 +/- 1.52).

CONCLUSION

Exposure to halothane or isoflurane anaesthesia increased the number of pulmonary metastases in C57B1 mice compared with the control groups but there was no difference in metastases among animals treated with halothane or isoflurane.

Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group

BACKGROUND

Mild perioperative hypothermia, which is common during major surgery, may promote surgical-wound infection by triggering thermoregulatory vasoconstriction, which decreases subcutaneous oxygen tension. Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen. Hypothermia also directly impairs immune function. We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization.

METHODS

Two hundred patients undergoing colorectal surgery were randomly assigned to routine intraoperative thermal care (the hypothermia group) or additional warming (the normothermia group). The patient's anesthetic care was standardized, and they were all given cefamandole and metronidazole. In a double-blind protocol, their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks; wounds containing culture-positive pus were considered infected. The patients' surgeons remained unaware of the patients' group assignments.

RESULTS

The mean (+/- SD) final intraoperative core temperature was 34.7 +/- 0.6 degrees C in the hypothermia group and 36.6 +/- 0.5 degrees C in the normothermia group (P < 0.001) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia (19 percent) but in only 6 of 104 patients assigned to normothermia (6 percent, P = 0.009). The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia (P = 0.002), and the duration of hospitalization was prolonged by 2.6 days (approximately 20 percent) in hypothermia group (P = 0.01).

CONCLUSIONS

Hypothermia itself may delay healing and predispose patients to wound infections. Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations.

Mild intraoperative hypothermia reduces production of reactive oxygen intermediates by polymorphonuclear leukocytes

Mild hypothermia directly impairs numerous immune functions in vitro. However, the in vivo effects of mild hypothermia on neutrophil phagocytosis and oxidative killing remain unknown. We tested the hypothesis that mild intraoperative hypothermia decreases neutrophil phagocytic capacity and generation of reactive oxygen intermediates (a measure of oxidative killing). Additionally, we evaluated the effects of in vitro temperature manipulations on each function. Thermal management was randomly assigned in 10 surgical patients, causing intraoperative core temperatures to range from 33 to 37 degrees C. Production of reactive oxygen intermediates and neutrophil phagocytosis were evaluated using flow cytometry at ambient temperature. Phagocytic capacity was assessed by uptake of fluorescein isothiocyanate-labeled Escherichia coli. Reactive oxygen production was estimated by the intracellular conversion of dihydrorhodamine 123 to rhodamine 123. Blood samples were obtained preoperatively, 1 h after surgery started, and 2 h postoperatively. Blood was also obtained from 10 matched control subjects and tested at 32, 37, and 40 degrees C. Neutrophil oxidative and phagocytic capacities were significantly reduced intraoperatively, compared with preoperative and postoperative values. Intraoperative production of reactive oxygen species was linearly related to core temperature. In contrast, there was no correlation between core temperature and phagocytic activity. In vitro production of reactive oxygen intermediates increased sixfold from 32 to 40 degrees C. In vitro phagocytic capacity increased fourfold in this temperature range. Production of oxidative intermediates was most closely related to intraoperative core temperature, decreasing nearly fourfold over a 4 degree C range. This in vitro temperature dependence was matched in vitro. Impaired neutrophil oxidative killing may contribute to the observed hypothermia-induced reduction in resistance to infection.

Effect of general anaesthesia and surgery on neutrophil function

The effects of general anaesthesia and surgical trauma on neutrophil function were studied in 60 female ASA 1 and 2 patients undergoing anaesthesia for gynaecological surgery. Patients were divided into three groups depending on the degree of trauma and duration of surgery. Group 1 (n = 15) were patients for dilatation and curettage (minor surgical trauma) and were given 2% halothane. Group 2 (n = 30) had laparoscopic surgery (moderate surgical trauma) and received either 0.5% halothane or 1% enflurane. Group 3 (n = 15) were those having hysterectomy (major surgical trauma) and received 0.5% halothane for a longer duration. Venous samples were taken 30 min before anaesthesia (control value), 10 min after induction of anaesthesia, 10 min after the start of surgery, 30 min after the end of anaesthesia and 24 h later. Phagocytic index, nitroblue tetrazolium reduction test, total leucocyte count, and differential leucocyte counts were performed on each sample. Data were analysed by paired t-test to compare findings in the same patient and by unpaired t-test for differences between groups. Anaesthesia with halothane 0.5% to 2% caused a dose-related depressant effect on leucocyte function which reversed. Enflurane 1% on the other hand caused significantly greater depression of leucocyte function compared with 0.5% halothane which persisted during the recovery period and recovered on the first postoperative day. Total leucocyte counts also showed a fivefold increase in the major surgery groups.

Impaired neutrophil chemotaxis after cardiac surgery

Chemotaxis of circulating peripheral neutrophils was studied in 12 patients undergoing elective cardiac surgery. Tests of neutrophil chemotaxis were made preoperatively and 16-20 hours postoperatively, using a multipore filter assay. Statistically significant postoperative decrease was demonstrated in both stimulated and random neutrophil migration (p = 0.012 and p = 0.009, respectively). Although the peripheral neutrophil count showed a statistically significant postoperative increase (p = 0.001), the increase did not correlate to the decrease in neutrophil chemotaxis. Nor could correlation be demonstrated between the altered neutrophil chemotaxis and any per- or postoperative variables.

Polymorphonuclear leukocyte behavior in a nonhuman primate focal ischemia model

There is increasing interest in the role of polymorphonuclear (PMN) leukocytes in the evolution of focal cerebral infarction. Surgical preparation of focal cerebral ischemia models may alter leukocyte reactivity and thereby make interpretation of leukocyte function following ischemia/reperfusion difficult. The effects of surgical preparation and of experimental ischemia/reperfusion on granulocyte function have been examined prospectively in a baboon model. Twenty-six adolescent male baboons underwent surgical preparation, of which 21 underwent middle cerebral artery occlusion/reperfusion. Four additional animals served as nonsurgical controls. Peripheral venous blood specimens were taken for performing assays of leukocyte function at defined intervals before and after both the surgical preparation (i.e., the overall procedure for implantation of the middle cerebral artery occlusion device) and occlusion/reperfusion. A stress-related elevation in total leukocyte number was attributed mainly to an increase in the number of circulating PMN leukocytes. Values rose from 13.9 +/- 4.9 x 10(3) to 27.8 +/- 5.8 x 10(3)/microliters, (+/- SD; n = 21) for total leukocyte number, with p < 0.001, and from 4.3 +/- 2.1 x 10(3) to 15.9 +/- 4.7 x 10(3)/microliters (n = 21) for PMN leukocytes, with p < 0.001. Surgical preparation had no effect (p > or = 0.4) on the ability of PMN leukocytes, isolated 24 h after the implantation procedure, to display polarization, O2.- production, or beta-glucuronidase release when stimulated with human C5a. A moderate decrease in the chemotactic response to C5a resolved within the 7-day postsurgery (preocclusion) period. Three-hour middle cerebral artery occlusion and 1-h reperfusion resulted in a significant reduction in C5a-induced polarization.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of propofol and thiopentone on polymorphonuclear leukocyte functions in vitro

Anesthetic agents may impair host defense mechanisms including polymorphonuclear leukocyte (PMNL) function. We have studied the effects of thiopentone and propofol in low (thiopentone 10 mg/L, propofol 2 mg/l) and high (thiopentone 40 mg/L, propofol 6 mg/L) clinically relevant concentrations on PMNL adherence, chemotaxis, phagocytosis and killing in vitro. The results demonstrated that thiopentone in both concentrations significantly decreases all PMNL functions tested and had a direct influence on the PMNLs in terms of their chemotactic response. In contrast, propofol decreases significantly only PMNL chemotaxis but not adherence, phagocytosis and killing. The effect of propofol was not attributable to the lipid carrier vehicle, as Intralipid with same formulation had no effect on PMNL function. We conclude that propofol is a relatively safe agent from the viewpoint of PMNL function in vitro, which may be of potential clinical benefit.

Mild hypothermia during isoflurane anesthesia decreases resistance to E. coli dermal infection in guinea pigs

Small changes in core temperature profoundly alter cutaneous blood flow, a major factor influencing resistance to wound infection. Furthermore, when measured in vitro, various immune functions are temperature dependent in the physiological range. Accordingly, we tested the hypothesis that mild hypothermia impairs and mild hyperthermia improves resistance to dermal infections. Thirty-two guinea pigs were anesthetized for 6 h using 1.5% (1.25 MAC) inspired isoflurane. Their core temperatures were maintained at either 39 degrees C (normal for guinea pigs, n = 11), 36 degrees C (n = 12), or 41 degrees C (n = 9). One h after induction of anesthesia, 2 x 10(8) E. coli were injected intradermally with a 26-g needle at eight sites on each animal's back. Core temperatures were not controlled after recovery from anesthesia, and animals in each group were maintained in the same environment. Twenty-four h after injection, the area of induration surrounding each injection site was measured. This is a standard test of resistance to wound infection. Values were compared using one-way ANOVA and Scheffé's S tests. Results are presented as means +/- standard deviations; differences were considered significant when P < 0.05. Areas of inflammation on the hypothermic animals were significantly larger (48 +/- 10 mm2) than those on normothermic (36 +/- 10 mm2) or hyperthermic (37 +/- 6 mm2) animals. These data suggest that mild hypothermia during anesthesia significantly impairs resistance to dermal infection. In contrast, mild hyperthermia does not appear to be protective.

Effects of anaesthetics on membrane mobility and locomotor responses of human neutrophils

The morphological response of neutrophils to chemotactic factors is characterized by an immediate change (in seconds) from a spherical to an irregular shape. Within two or three minutes, the cells assume the head-tail polarity typical of locomotor cells. In this study the effects of the anaesthetic drugs, propofol and thiopentone, on the time-sequence of the morphological response of human neutrophils to the chemotactic peptide fMet-Leu-Phe were examined. At concentrations seen in the plasma during anaesthesia, both drugs inhibited both the rate and degree of the neutrophil chemotactic response. The effect of propofol was not attributable to its lipid vehicle, as 10% intralipid alone had no effect on neutrophil polarization. Plasma membrane reorganization occurs during polarization of neutrophils, resulting in morphological and functional changes which prepare the cells for chemotaxis and phagocytosis. Fluorescence recovery after photobleaching (FRAP) was used to investigate effects of the anaesthetics on membrane lipid behaviour. With a lipid probe, the proportion of mobile lipid in neutrophils exposed to propofol or thiopentone was reduced. There was a less significant reduction with intralipid which also caused reduction in velocity of lateral diffusion of the probe. These findings suggest that the inhibitory effects of anaesthetics on neutrophil locomotion are related to reductions in fluid mobility of the plasma membranes of anaesthetic-treated cells.

Neutrophils from patients undergoing hip surgery exhibit enhanced movement under spinal anaesthesia compared with general anaesthesia

The purpose of this research was to investigate whether the effects of regional anaesthesia on neutrophil migration differ from those due to general anaesthesia during major orthopaedic surgery in human patients. Eighteen patients underwent spinal or general anaesthesia (halothane or isoflurane) for surgery (six patients in each group). Blood samples were taken prior to induction of anaesthesia and after surgery was in progress for one hour. The movement of isolated neutrophils was measured in both samples in the chemotactic chamber toward lipopolysaccharide activated pooled serum. In addition plasma concentrations of catecholamines were determined in the blood samples. Neutrophils extracted from peripheral blood during spinal anaesthesia and surgery moved further towards a complement-derived attractant than neutrophils obtained from patients undergoing surgery under general anaesthesia with halothane or isoflurane and surgery (156.4 +/- 7.6 microns vs 114.3 +/- 6.1 microns or 119 +/- 8.4 microns respectively, P < 0.05). Increased concentrations of adrenaline were present in both general anaesthetic groups whereas the spinal group had lower concentrations than those prior to anaesthesia and surgery. It is considered unlikely that these differences in neutrophil reactivity are due to the direct effects of anaesthetic agents employed. The effects are likely to be the result of differing effects of spinal anaesthesia on the stress response or immunological mediators.

Changes of expression of endogenous sugar receptors by polymorphonuclear leukocytes after prolonged anaesthesia and surgery

Anaesthesia and surgery are known to depress granulocyte function in the early postoperative period, leading to deterioration of the immune defence against infection. Carbohydrate-lectin interactions may play an important role in the activities of phagocytic cells in that they facilitate initial host defence in the event of microbial antigenic challenge. A panel of biotinylated (neo)glycoproteins (chemically glycosilated carrier proteins) was used to detect endogenous carbohydrate-binding receptors /lectins/, on peripheral blood polymorphonuclear leukocytes of patients undergoing prolonged anaesthesia for replantation surgery. Four hours after induction of anaesthesia, a progressive decline of expression of endogenous sugar receptors on granulocytes was detected using the labelled (neo)glycoproteins lactose-BSA, N-acetyl-D-glucosamine-BSA, D-mannose-BSA, sialic-acid-BSA and D-xylose-BSA. Concomitant changes in peripheral white blood cell counts and the lack of depression in the absence of general anaesthetic agents suggested the existence of a possible relationship between reduced expression of (neo)glycoprotein receptors to impaired granulocyte function and anaesthetic-induced immunodepression.

Effects of thiopental on granulocyte oxidative microbicidal capacity

Some anaesthetics are known to depress granulocyte chemiluminescence responses in the phagocytosis of zymosan as a measure of their oxidative microbicidal capacity. In this study the effects of thiopental were measured on chemiluminescence responses in the phagocytosis of Staphylococcus aureus and Escherichia coli, which are the commonest bacteria causing postoperative infections. Granulocytes from 14 healthy volunteers (mean age 35 +/- 9 (s.d.) years) were tested in vitro in the presence of clinical thiopental concentrations 0, 5, 10 and 25 micrograms/ml (0, 18, 36 and 91 mumol/l, respectively). During a 60-min exposure period, decreased chemiluminescence responses occurred to Staph. aureus at 5 micrograms/ml (P less than 0.01) and higher thiopental concentrations and to E. coli at 10 micrograms/ml (P less than 0.01) and higher concentrations, as a sign of depressed oxidative microbicidal activity.

Dual effect of thiopentone on human granulocyte activation. Non-intervention by ketamine and morphine

The immune system, defending our organism against infections, can also cause disease. Anaesthetics may impair immunological defence by modifying the number and functions of immunocompetent cells, including the polymorphonuclear leucocytes (PMN). We have studied the effects of thiopentone, ketamine and morphine on some stimulated PMN responses that presumably reflect their microbicidal activity, i.e. oxygen consumption, aggregation, and volume increase. Stimulators were N-formyl-methionyl-leucyl-phenylalanine (FMLP, affecting cells via specific membrane receptors) and phorbol-myristate-acetate (PMA, activating protein kinase C, thereby short-cutting intramembraneous steps in normal signal transmission, and presumably provoking near-maximal cell responses with the dose applied). Preincubation of PMN with low doses of thiopentone enhanced oxygen consumption in unstimulated cells as well as in response to FMLP, but not PMA. FMLP-stimulated volume and aggregation responses were not detectably affected. The highest concentration of thiopentone depressed both oxygen uptake and volume/aggregation responses in FMLP-stimulated PMN. The amount of oxygen consumed after PMA stimulation was not affected, but both the onset of increased consumption and the maximal response were delayed. The two other drugs investigated, ketamine and morphine, did not appreciably affect oxygen consumption or aggregation by PMN: neither the baseline values nor those obtained after FMLP or PMA stimulation.

Neutrophil mobility during anaesthesia in children. A trial of ascorbate premedication

In 20 healthy children undergoing elective surgery, mobility of neutrophils, both unstimulated and stimulated by endotoxin, was studied using a millipore filter system with microscopic determination of leading front migration. Paired samples were incubated with 10(-2) mol l-1 calcium ascorbate and ten children also received 10 mg kg-1 ascorbic acid before premedication. Stimulation of mobility was reduced after the opioid premedication (P less than 0.05) in the ascorbate group only, but not significantly during anaesthesia and surgery. A few individuals showed persisting abnormally low values. No effect of ascorbate in vivo or in vitro was demonstrated. There were no infections.

Effect of lidocaine on the function of immunocompetent cells. II. Chronic in vivo exposure and its effects on mouse lymphocyte activation and expression of immunity

In vivo exposure of mice to lidocaine (0.25 mg/10 g body weight 4 times a day for 7 days) resulted in impairment of immunocompetent cell function. Spleen lymphocytes removed from animals immediately and 3 days after lidocaine exposure showed changes in their surface charge properties, inhibition of blastogenesis in response to concanavalin A and lipopolysaccharide, and inhibition of antigen-stimulated activation as measured by the mixed lymphocyte reaction. Lymphocytes from animals sensitized to keyhole limpet hemocyanin showed a significantly lower capacity to produce macrophage migration inhibitory factor 8 days after termination of exposure to lidocaine. Animals exposed to the drug were unable to accumulate an adequate number of immunocompetent cells at the site of challenge with a foreign substance (i.e. dextran), and the ability of the animals to destroy tumor cells nonspecifically and specifically was also impaired. The results indicated that chronic exposure to lidocaine resulted in impairment of lymphocyte function, even in the subsequent absence of the drug, and in significant changes in the expression of the immune response.

Comparative effects of volatile anaesthetic agents and nitrous oxide on human leucocyte chemotaxis in vitro

Infection following surgery is not uncommon. Human leucocytes play a vital role in the body's defense against infection. In order to decrease perioperative morbidity and mortality from infection, it is important to define the comparative effects of different anaesthetic agents on the leucocyte function. Therefore, the effect of equipotent concentrations (MAC 1) of isoflurane, enflurane, halothane, methoxyflurane and 70 per cent nitrous oxide, on the leucocyte chemotactic migration was investigated in vitro. The chemotactic migration of neutrophils and monocytes, with and without equilibration with MAC 1 concentrations of different volatile anaesthetics and 70 per cent nitrous oxide, was compared by using a modification of Boyden's method. Chemotactic migration of both cell types was unaffected by isoflurane, but a significant depression of chemotactic migration was observed with enflurane, halothane, methoxyflurane and nitrous oxide (p less than 0.05). The severity of depression of migration was maximal with nitrous oxide, followed by methoxyflurane, halothane and enflurane in order. It is concluded that equipotent concentrations of various anaesthetic agents produce different degrees of depression of leucocyte chemotactic migration in vitro.