Effects of Propofol anesthesia combined with remifentanil on inflammation, stress
response and immune function in children undergoing tonsil and adenoid surgery
Authors: Xiaoqin Yang  , Xuechun Wu  , Bin Qin  , Zaiping Wang  , Xianlin Zhu  , Shaowu Huang  
Published: July 2022

The purpose of this study was to investigate the effects of propofol anesthesia combined with
remifentanil on inflammation, stress response, and immune function in children undergoing tonsil and
adenoid surgery. For this aim, 126 children admitted to our hospital for elective temperature-controlled
radio-frequency of tonsils and adenoids from October 2020 to September 2021 were randomly divided
into an observation group (n=63) and a control group (n=63). The observation group was anesthetized
with propofol in combination with remifentanil, while the control group underwent propofol combined
with ketamine. The mean arterial pressure (MAP), heart rate, serum C-reactive protein (CRP),
interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), epinephrine, cortisol (Cor), CD3+ T
lymphocytes, CD4+ helper T lymphocytes, CD8+ suppressor T lymphocytes and CD4+/CD8+ ratio were
compared between the two groups before induction of anaesthesia (T1), upon intubation (T2), at the
beginning of surgery (T3), at the end of surgery (T4) and 5 min after extubation (T5). -(TNF-α). The
recovery time from anaesthesia and adverse reactions after extubation were observed in the two groups.
Results showed that the MAP and heart rate in both groups increased significantly at T2 compared to T1,
but the observation group had lower values than the control group after the maintenance of anaesthesia
(P<0.05). Serum CRP, IL-6 and TNF-α levels increased with time in both groups, and the increase was
considered significant (P<0.05). In addition, serum epinephrine and Cor levels gradually rose from T1 to
T4 in both groups, and then decreased at T5. The difference was statistically significant (P<0.05)
between any two-time points. CRP, IL-6, TNF-α, epinephrine and Cor in the observation group were
significantly lower than those in the control group from T3 to T5 (P<0.05). CD3+, CD4+ and
CD4+/CD8+ ratio decreased whereas CD8+ went up in both groups at T4 and T5, and which were
considered statistically significant when compared with data from T1 to T3 (P<0.05). However, CD3+,
CD4+, CD8+ and CD4+/CD8+ ratios did not differ statistically significantly between the two groups at
each time point (P>0.05). In the observation group, the time to recovery of spontaneous respiration, the
time to resumption of limb movements and the span from discontinuation of anaesthetic to extubation
were all significantly shorter than those in the control group, and the incidence of agitation during the
awakening period was lower than that in the control group (P<0.05). Then propofol combined with
remifentanil is more effective in inflammation, stress response and immune function in anesthetizing
children undergoing tonsil and adenoid surgery. The observation group presented more stable
hemodynamics, lower levels of inflammation and stress reactions, rapid awakening and fewer adverse
effects, so the combination therapy was worthy of clinical promotion in pediatric surgery requiring
general anesthesia.