Document 0957
 DOCN  M9650957
 TI    [Evaluation of regional analgesia and surgical trauma on selected
       factors of the human immune system]
 DT    9505
 AU    Gajdosz R; Kliniczny Oddzial Anestezjologii i Intensywnej Terapii 5;
       Wojskowego Szpitala Klinicznego w Krakowie.
 SO    Folia Med Cracov. 1994;35(1-4):69-86. Unique Identifier : AIDSLINE
       MED/96135481
 AB    The work attempted to explain the influence of epidural analgesia and
       operations on the behaviour of complement and lymphocyte systems. There
       are very few theses in the world anaesthetic literature which attempt to
       explain the influence of analgesia and operations on the immune system.
       Moreover, the problem is treated very superficially in these theses and
       research was conducted on a small number of patients. In the face of
       this fact it was decided to assess the behaviour of selected factors of
       the immune system during analgesia and operations. The research
       encompassed approximately 80 patients who underwent analgesia and
       operations. The operated patients were divided into two groups: a
       40-person research group A and a 40-person control group K. In group A
       resection of the prostate gland was performed in epidural analgesia,
       whereas group K underwent analgesia of the brachial plexus to be
       operated within the hand and the upper limb. Because of the small extent
       of sympathetic interruption and of the operation the K group was the
       control group in relation to the A group where the sympathetic
       interruption and the operation were extensive. During the analgesia,
       operation and the 7-day post-operation period the concentration of
       immunoglobulins was examined (IgG, IgA, IgM), components of the
       complement (C3, C4), the total haemolithic activity of the complement
       (Kc) as well lymphocyte populations and sub-populations (B, T, CD4,
       CD8). Modern research techniques were used to carry out these
       examinations: monoclone antibody for examining lymphocytes,
       nephelometric technique for examining concentration of immunoglobulins
       and components of the complement and the hemolithic method for
       examination of the total activity of the complement. It was found that
       epidural analgesia acts deeply depressively on the concentration of
       endogenous immunoglobulins and of the components of the complement
       during the day of the operation. This type of analgesia also a similar
       effect on the level of total haemolithic activity of the complement.
       Operation trauma on the other hand causes depression of the auxiliary T
       lymphocyte population (CD4) and the stimulation of the cytotoxic T cell
       subpopulation (CD8) with a pathological reduction of the quotient factor
       of these lymphocyte sub-populations CD4/CD8. No statistically
       significant immunologic disorders were found in the area of the factors
       examined in patients who underwent operations in the area of the hand
       and the upper limb with application of plexus analgesia. The presented
       research results--although they do not have a correspondent in the world
       anaesthetic literature--seem to prove that epidural analgesia, hitherto
       regarded as a safe manner of anaesthetizing patients for operations is
       not devoid of negative influences on the immune system. With regard to
       immunity on the other hand, plexus analgesia seems to be a safe method
       anaesthetizing patients for operations in the area of the upper limb. It
       seems that the extent of sympathetic interruption caused by epidural
       analgesia affects selected immune factors depressively. This is a
       clinical question which still requires much research, especially in the
       area of effect on the immune system because post operative infection
       complications still constitute an important etiopathogenetic and medical
       problem.
 DE    Aged  Aged, 80 and over  Analgesia, Epidural/*ADVERSE EFFECTS
       Anesthesia, Spinal/ADVERSE EFFECTS  Brachial Plexus
       Complement/IMMUNOLOGY  CD4-CD8 Ratio  English Abstract  Hand/SURGERY
       Human  Immunoglobulins/*IMMUNOLOGY  Lymphocyte Subsets/IMMUNOLOGY
       Lymphocytes/*IMMUNOLOGY  Male  Middle Age  Prostate/SURGERY  Surgery,
       Operative/*ADVERSE EFFECTS  T-Lymphocytes/IMMUNOLOGY  CLINICAL TRIAL
       CONTROLLED CLINICAL TRIAL  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).