Anesthesia, Immunotoxicity, Inert Gas Narcosis
Conditions
Brief summary
Anesthesia depth affects the proliferation of lymphocytes to NK-cells and memory T-cells effect and the phagocytosis activity of macrophages in healthy patients. ASA 1-3 subjects undergoing extended shoulder surgery under continuous regional anesthesia randomly were assigned to a deep or a shallow anesthesia level (BIS \<35 or \>55) for more than an hour. Immune response is measured by lymphocyte proliferation as well as neutrophil and monocyte phagocytosis activity.
Detailed description
Blood samples were taken under minimal stress prior to anesthesia induction (T0), recovery (T1) and 12 weeks following hospital discharge (T2) from the respective anesthesia depth level. Bispectral index monitoring (BIS) was performed from the awake state to complete recovery in all subjects. Hemoglobin concentration, leukocyte and lymphocyte counts were determined by routine automated laboratory techniques. Lymphocyte proliferation was analyzed by SASPA flow cytometry analysis. In brief, 100 µl EDTA blood were stirred with 10 µl FITC and PE marked antibody mixture containing CD3, CD4, CD8, CD 16, CD45, CD28, CD27, CD 56. Monocyte and neutrophil phagocytosis activity was measured separately in macrophages of fresh heparinized whole blood using flow cytometric test kits. Proteomics of monocytes was done synchronously.
Interventions
DRUGHigh dose propofol, fentanyl and sevoflurane
Deep Anesthesia
DRUGLow dose propofol, fentanyl and sevoflurane
Shallow Anesthesia
Sponsors
Heidelberg University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* enrolment for longer shoulder surgery * consent for the standard anesthesia form in combination with the interscalene plexus block * ASA Status 1-3
Exclusion criteria
* sedative premedication * severe immune deficiency (diabetes, steroid or antihistamine medication, cancer, chemotherapy, * status post transplantation, drug and alcohol abuse), * recent surgery (1 month) or blood transfusion
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Depression of lymphocyte proliferation by CD expression pattern in SASPA-Test as given in a percentage from before anesthesia | 70-90 min | before and following anesthesia period over 60 min |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Reduction of phagocytosis activity as a percentage of base line (prior to anesthesia) | 70-90 min | before and following anesthesia period over 60 min |
| Protein expression pattern of monocytes by proteomics analysis and mass spectrometry | 70-90 min | before and following anesthesia period over 60 min |
Countries
Germany
Outcome results
None listed