Abstract
Background: This study was purposed to compare in vitro the volumetric accuracy of a newly introduced automatic infusion controller, AutoClamp with that of other commonly used infusion devices. Methods: In this prospective, randomized, controlled trial, 124 ASA I-II, female patients, aged 30-50 years, undergoing conservative breast cancer surgery were randomly assigned to one of four equal groups receiving either standard general anesthesia and two doses of hydrocortisone (Group GH, n=31), thoracic paravertebral block and two doses of hydrocortisone (Group PH, n=31), standard general anesthesia with no hydrocortisone (Group G, n=31), or thoracic paravertebral block with no hydrocortisone (Group P, n=31). IL-6 was measured at three time points: before operation, 6 and 12 hours postoperatively. CRP and cortisol were measured preoperatively and 6 hours postoperatively. Results: On comparing group PH and GH, there was significant decrease in IL-6 level in group PH compared to group GH at 6 hour (122.1±21.2 vs 135.8±29.8pg/dl), but insignificant difference at 24 hours (107.9±21.6 vs 106.8±15.9pg/dl). CRP showed significant decrease in the postoperative reading in group PH compared to group GH (1.63±0.32 vs 1.91±0.43mg/l), and also group PH showed significant decrease compared to the control group P (1.63±0.32 vs 2.2±0.54). Conclusion: addition of hydrocortisone to general anesthesia or thoracic paravertebral block attenuated production of IL-6 and CRP levels significantly postoperatively compared to either anesthetic regimen alone, but not the serum cortisol level, highlighting its role in modifying the stress response to surgery. However, the effect was more pronounced when combined with thoracic paravertebral block.
Highlights
The cytokines are low-molecular-weight heterogenous proteins which include interleukins and interferons
On comparing group PH and GH, there was significant decrease in interleukin 6 (IL-6) level in group PH compared to group GH at 6 hour (122.1±21.2 vs 135.8±29.8pg/dl), but insignificant difference at 24 hours (107.9±21.6 vs 106.8±15.9pg/dl)
C-reactive protein (CRP) showed significant decrease in the postoperative reading in group PH compared to group GH (1.63±0.32 vs 1.91±0.43mg/l), and group PH showed significant decrease compared to the control group P (1.63±0.32 vs 2.2±0.54)
Summary
The cytokines are low-molecular-weight heterogenous proteins which include interleukins and interferons. The main cytokines released are interleukin-1 (IL-1), tumor necrosis factor- (TNF-) and Interleukin (IL-6) [1] They have a major role in the inflammatory response to malignancy, trauma and surgery, inducing local and systemic effects which attempt to limit injury and seem to be directly involved in the symptomatology of sepsis, multiorgan failure and septic shock [2]. The use of hydrocortisone led to significant decrease of the inflammatory response among patients undergoing bilateral total knee replacement indicated by measuring IL-6 production [12] This prospective, randomized, controlled study was performed to evaluate possible differences in the plasma inflammatory cytokine interleukin 6 (IL-6), the release of the stress hormones (cortisol), and C-reactive protein (CRP) by adding hydrocortisone to two different anesthetic regimens in a population of healthy female patients with cancer breast undergoing unilateral conservative breast cancer surgery. We evaluated the role of adding hydrocortisone to two different anesthetic regimens, on the level of IL-6, CRP and cortisol levels following breast cancer surgery
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