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IL-6 response in patients with diabetes mellitus type 2 after general and spinal anesthesia

Background and Goal of Study: Surgery and anesthesia cause immunosuppression in operated patients. Anesthesia modulates immune response, diminishing stress reaction to the surgery, but it also has suppressive effects on a number of immune factors and processes. Due to their disturbed immunity and low-grade chronic inflammation present years before the first occurrence of simptoms of disease, patients with diabetes are a group at special risk of developing infections. Important question raises whether selection of anesthetics and anesthetic metod contributes to the immune system disorder in immunocompromised patients, including diabetics. Anesthesiologist must think about the immune actions and effects of anesthetics and choose drugs and anesthetic method after careful consideration of the immune status of the patient. Aim of this study was to determine whether there is a difference in preoperative concentrations of IL-6 in patients with diabetes type 2 compered to controls, whether there is different stress response in diabetics compered to controls (postoperative values of IL-6) and whether there is difference in the cytokine response under spinal and general anesthesia. Materials and Methods: 60 patients with diabetes mellitus type 2 (Group A) and 30 patients without diabetes as a control (Group B ) were included in study. IL-6 was measured in 3 peripheral venous blood samples: 1) before induction of general and spinal anesthesia (A1), 2) at the end of surgery (A2), and 3) 24 hours after the first sampling (A3). Results and Discussion: The results show that in both types of anesthesia (spinal and general) there was a significant increase in IL-6 (P< 0, 001 in both groups). When comparing IL-6 values in patients according to type of anesthesia, there was no significant difference between Group A and B. Preoperative values of IL-6 did not differ significatly betwen Group A and B, as well as postoperative values (respons to surgical stress). Conclusion(s): In all patients (with and without diabetes), regardless of the type of anesthesia, postoperative immunosuppression occurs. We did not confirm altered response to anesthesia and surgical stress in patients with diabetes mellitus type 2. Although it is believed that regional anesthesia diminish stress response, in this study we did not confirm that spinal anesthesia had effects on postoperative IL-6 concetration in terms of reducing operating stress, and consequently, immunosuppression.

IL-6 ; postoperative immunosuppression ; diabetes mellitus type 2

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