Evaluation of Stress Response and Apoptosis on Leucocytes in TIVA versus Balanced Anesthesia

Abstract

Background: The aim of this study was to assess the stress response and apoptosis on leucocytes, in patients under two different anesthetics techniques. Methods: Thirty patients ASA I-II were prospectively randomized into two groups to receive either total intravenous anesthesia with propofol-remifentanil (TIVA Group, n = 15) or balanced inhalation anesthesia with sevoflurane-remifentanil (BAL Group, n = 15). The hemodynamic response: systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) at different time points: baseline, after intubation, after skin incision and at the end of surgery, was measured along with plasma levels of lactate, glucose, cortisol and leucocytes count. The biomarkers of apoptosis (Annexin V and Propidium Iodide) in neutrophils, monocytes and lymphocytes were evaluated at baseline, intraoperatively and two hours after surgery. Results: The study groups were comparable with respect to anthropometric data. No significant intergroup differences in SBP and DBP were revealed. The HR in the BAL group was lower after intubation (p = 0.007). In both groups, lactate, plasma glucose, cortisol and leucocytes count remained stable during surgery and two hours post-operatively. In the BAL group there were significant differences in Annexin V in neutrophils, baseline moment (p = 0.010). No significant differences were found in apoptosis markers (Annexin V and Propidium Iodide) in neutrophils, monocytes and lymphocytes, at different time points. Conclusion: Both TIVA and BAL were effective in suppressing the surgical stress, without inducing apoptosis in immune cells, in patients undergoing VCL.