Abstract
BackgroundSurgery and diseases modify inflammatory responses and the immune system. Anesthetic agents also have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses. The aim of this study was to assess how single-drug dexmedetomidine and propofol anesthesia without any surgical intervention alter acute immunological biomarkers in healthy subjects.MethodsThirty-five healthy, young male subjects were anesthetized using increasing concentrations of dexmedetomidine (n = 18) or propofol (n = 17) until loss of responsiveness (LOR) was detected. The treatment allocation was randomized. Multi-parametric immunoassays for the detection of 48 cytokines, chemokines and growth factors were used. Concentrations were determined at baseline and at the highest drug concentration for each subject.ResultsThe changes in the concentration of eotaxin (decrease after dexmedetomidine) and platelet-derived growth factor (PDGF, increase after propofol) were statistically significantly different between the groups. Significant changes were detected within both groups; the concentrations of monocyte chemotactic protein 1, chemokine ligand 27 and macrophage migration inhibitory factor were lower in both groups after the drug administration. Dexmedetomidine decreased the concentration of eotaxin, interleukin-18, interleukin-2Rα, stem cell factor, stem cell growth factor and vascular endothelial growth factor, and propofol decreased significantly the levels of hepatocyte growth factor, IFN-γ-induced protein 10 and monokine induced by IFN-γ, and increased the levels of interleukin-17, interleukin-5, interleukin-7 and PDGF.ConclusionsDexmedetomidine seemed to have an immunosuppressive effect on the immune system whereas propofol seemed to induce mixed pro- and anti-inflammatory effects on the immune system. The choice of anesthetic agent could be relevant when treating patients with compromised immunological defense mechanisms.Trial registrationBefore subject enrollment, the study was registered in the European Clinical Trials database (EudraCT number 2013–001496-21, The Neural Mechanisms of Anesthesia and Human Consciousness) and in ClinicalTrials.gov (Principal Investigator: Harry Scheinin, number NCT01889004, The Neural Mechanisms of Anesthesia and Human Consciousness, Part 2, on the 23rd of June 2013).
Highlights
IntroductionAnesthetic agents have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses
Surgery and diseases modify inflammatory responses and the immune system
We investigated the effects of dexmedetomidine and propofol to the ratio of Th1 to Th2 cytokines, Interferon e.g. interferon-γ (IFN)-γ to Interleukin e.g. interleukin-6 (IL)-4 and IL-5, but we found no statistically significant differences
Summary
Anesthetic agents have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses. Surgery is known to trigger an inflammatory reaction [1], the magnitude of which depends on the type of surgery and the extent of tissue injury [2] This postsurgical inflammatory reaction is followed by depression in cell mediated immunity, which in turn predisposes patients to postoperative infections and sepsis [3]. The effects of anesthetic agents on inflammatory cytokine profiles have previously been determined mostly in surgical patients or patients with critical illnesses, when the immunological status has inevitably been altered due to the surgical intervention, co-medication and/or the underlying disease [6,7,8]. Considering several confounding factors and wide methodological variation between the previous studies, it is not surprising that contradictory results have been obtained [4, 10]
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