Influence of anaesthesia on the immune status of patients with malignant neoplasms in oropharyngeal region
Authors:   MD, Department of Anesthesiology and Resuscitation, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Vasileiv D.N. , Kulbakin D.E. ,   MD, DSc, Senior Researcher, Head of Department of Head and Neck Tumors, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Choynzonov E.L. ,   MD, DSc, Professor, Member of the Russian Academy of Sciences, Director of the Cancer Research Institute, Tomsk NRMC; Department of Head and Neck Tumors Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Avdeev S.V. ,   MD, DSc, Department of Anesthesiology and Resuscitation, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Stakheyeva M.N. ,   MD, DSc, Laboratory of molecular oncology and immunology, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Gerdt L.W. ,   MD, Laboratory of molecular oncology and immunology, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Lee A.A. ,   MD, Head of Department of Anesthesiology and Resuscitation, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Azovskaya D.Y. ,   MD, Department of Head and Neck Tumors, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Shishkin D.A. ,   MD, Department of Head and Neck Tumors, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia), Shvetsova A.V. ,   Nurse of Department of Anesthesiology and Resuscitation, Cancer Research Institute, Tomsk NRMC (Tomsk, Russia)
Published: January 2025

The immune system, as the main factor in protecting the body from the action of infectious, viral agents, as well as performing anticancer surveillance, undergoes a number of negative changes during surgery. With surgical intervention that causes a stress response and the effects of anesthetics, immunosuppression is formed, which in turn reduces the quality of medical care to patients, increases the duration of hospital stay, as well as the development of a number of complications. The purpose of the study was to evaluate the effect of pre-carbohydrate loading and perioperative administration of dalargin on immunity indicators in patients who underwent surgery for malignant neoplasms of the oropharyngeal region. Materials and methods. 58 patients operated on for malignant neoplasms of the oropharyngeal region were examined. Patients are divided into 2 groups. In the main group (n=29), patients received a carbohydrate load of 400 ml for 12 hours and 200 ml for 2 hours before surgery, used multicomponent general anesthesia with the introduction of dalargin at a dosage of 45-55 mcg/kg/min, at the end of the operation, dalargin was administered 1 mg intramuscularly. In the control group (n=29) was multicomponent general anesthesia. The morphological composition of blood, the content of cytokines (IL-1β, -6, -8, -10, INF-γ and TNF-α) and immunoglobulins (IgA, IgM, IgG) were determined. Results. The level of lymphocytes in the postoperative period up to 7 days was significantly higher in the main group than in the control group, where there was a decrease in this indicator relative to the preoperative level. A significant increase in rod-shaped neutrophils in the control group also persisted up to 7 days after surgery. On the 1st day after surgery, the cytokine content significantly increased in both groups. The values of IL-1ß, IL-6, IL-8, INF-γ, TNF-α were significantly higher in the control group, however, on the 7th day after surgery, significant differences between the groups remained only in the indicators of IL-8, INF-γ. When assessing the level of immunoglobulins, statistically significant differences were revealed between the groups – in the main group, the concentration of IgA on day 1 and IgG on day 7 after surgery was higher. The content of CRP in both groups increased significantly on the next day after surgery, and in the main group the indicators were statistically significantly lower compared to the control group. The level of CRP in both groups remained above the initial values up to 7 days after surgery. Conclusion. The use of enkephalin, dalargin, as a component of anesthetic support in the perioperative period in the surgical treatment of malignant neoplasms of the oropharyngeal region is associated with a lower concentration of pro-inflammatory interleukins, an increase in IgG concentration compared with endotracheal multicomponent anesthesia and may contribute to the activation of an antitumor immune response.
Keywords: dalargin, anesthesia, immunity, depression, stress protection.