engleski

Neuroimmunomodulation in stress by regional and general anaesthesia

Survival depends on the immune system’s ability to defend the body against attack from invading pathogens and injury. However, the extent of such a response is of critical importance ; deficient responses may result in secondary infections from immunosuppression and excessive responses can be more harmful than the original insult.Surgery elicits broad alterations in haemodynamic, endocrine-metabolic and immune responses. The inflammatory response is essential for structural and functional repair of injured tissue, as complement, granulocytes, macrophages and many other mediators are required for appropriate wound healing. Injury, surgical or traumatical is connected with the acute disorder of immunological system which is manifesting as increased inclination to infections. The inflammatory response is an important determinant of outcome after major surgery. Perioperative excessive stimulation of the inflammatory and haemostatic systems plays a role in the development of postoperative ileus, ischaemia-reperfusion syndromes (e.g. myocardial infarction), hypercoagulation syndromes (e.g. deep venous thrombosis) and pain ; together, these represent a significant fraction of major postoperative disorders. Regional anaestehsia administered local anaesthetics prevent or modulate many of these processes. In the center of interests there are the serum-levels of Th1 i Th2 cytokines before and after regional and general anaesthesia and in such a way would like to confirm through the immunological status that the spinal anaesthesia is significantly more favourable for the patient. General or regional anaesthesia alone, without operation, has periodical and minimum effects to immunological system. It is established that various anaesthesiological procedures in the same operation cause various trend of alteration of cytokine level in serum . Spinal anaesthesia results in less immunosupression, i.e. maintains the number of Th1 cells, thus stimulating the cell immunity. Serious disorder of immunological system may cause complications as there are disorders in wound healing, increased number of infections, non-adequate response to the stress, multiorganic suppression and increased incidency of metastases.

Neuroimmunomodulation; stress; regional; general; anaesthesia

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