Tye dynamic of proinflammatory cytokines levels in parturients serum after caesarian section under total intravenous anaesthesia

Abstract

The cytokines are a group of polypeptide mediators of intercellular cooperation, participating mainly in forming and adjusting of protective reactions of organism at introduction of pathogens and violation of integrity of tissues, and also in adjusting of the normal physiological functions.Jin W.J. and other, 2013 [4] had proven that asters considerably have an influence with cognitive functions. Asters activating, induced by chronic cerebral hypoperfusion, results to cognitive dysfunctions. Hyppocampal proinflammatory cytokines (IL-1в, IL-6, ФНО α) have active negative influence with spatial memory for mice. The great number of works confirms a working hypothesis, that neuroinflammation has impact on development of the postoperative cognitive dysfunctions. The surgery duration and anaesthesia duration influence the postoperative cognitive dysfunctions was proven on animal models. This effect correlates with the changes of proinflammatory cytokines [3].The aim of this article is to study of the dynamic of proinflammatory cytokines levels (IL-6 and ФНО α) in parturients’ serum after caesarian section and total intravenous anaesthesia.Materials and methods. After local ethics committee approval and obtained informal consent, 15 parturients are inspected in the term of pregnancy of 37-42 weeks whose were delivered by the caesarian section under the total intravenous anaesthesia. Criteria of exception were: age to 18 and 45 more than, term of pregnancy to 36 weeks, severe preeclamsia or eclampsia, decompensated extragenital pathology, diabetes mellitus, psychical diseases, signs of bacterial or viral infection, mycoses, abandonment of woman from participating in the research at any of it stages, use ketamine in an anaesthetic manual. Total intravenous anaesthesia with mechanical lung ventilation (TIVA with MLV) : thiopental sodium 4 mgs/ kg, succinylcholine 1-1,5 mgs/ kg, after extraction of newborn is a phentanyl, by the scheme of 10-5-3 µgs/kg/hour and Diazepam 10 mgs. The depth of anaesthesia was controlled by measurement of BIS-index (monitor of BISX Module, BIS ™ Covidient, the USA). Duration of the caesarian section was 27,1±2,3 min. The operation and the anaesthesia had no any complications. For all the patients postoperative pain was less than 30-40 mm on VAS. The cytokines concentration was determined by the method of IFA analysis. We used on the kits of reagents JSC “VectorBest” А- 8756 for ФНОα with the range of measureable concentrations: 0-250 pg/ml. For IL - 6 was used on the kit of reagents Human IL-6 ELISA kit Diaclone (France) with the range of measureable concentrations: 0-200 pg/ml. The blood samples for analyses were taken: 1) at entering to the obstetrical department, 2) in a 24 hours after a surgery, 3) at discharge from hospital (5-7th postoperative day). Parameters of regional norm for IL-6 and ФНОα were measured for 15 unpregnant healthy women in age 25- 40. The blood samples for analyses were taken on an empty stomach at 9-11 a.m. The Normal value for IL-6 was 1,40±0,15 pg/ml (range 0,92-1,67 pg/ml, у=0,34). For ФНО α a level of normal values was 9,37±1,07 pg/ml (range 4,50-12,7 pg/ml, у=3,17).Conclusions. It is shown that IL-6 level has risen to the third trimester of pregnancy, while concentration of ФНОα goes down. At total intravenous anaesthesia with MLV by an intratracheal method concentration of IL-6 extremely increases in 24 hours after caesarean sections, and by a 5-7th day after surgery goes down significantly, although IL-6 level remains increased. Concentration of proinflammatory cytokine ФНО α at total intravenous anaesthesia remains significantly decreased in 24 hours after caesarean sections and continues to go down by 5-7th day after surgery.