Monocyte Subsets Altered by Anesthesia

Study Overview
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Brief Summary
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The impact of different anesthetic techniques on the immune system remains unclear. Aim of this ex vivo / in vitro study was to determine the effects of general and neuraxial anesthesia on monocyte subset alteration and the release of prototypical pro- and anti-inflammatory cytokines. Twenty patients undergoing total knee replacement surgery were randomly assigned to receive either general anesthesia (ITN) or combined spinal/epidural anesthesia (CSE). CD14 and HLA-DR expression patterns on monocytes and intracellular TNF-alpha production were quantified via flow cytometry. TNF-α and IL-10 release were measured via enzyme linked immunosorbent assay (ELISA).

Detailed Description
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Numerous of factors affect the immunological response during surgery. Despite intensive research, the impact of different anesthetic techniques on the immune system remains unclear. Aim of this ex vivo / in vitro study was to determine the effects of general and neuraxial anesthesia on monocyte subset alteration and the release of prototypical pro- and anti-inflammatory cytokines. Twenty patients undergoing total knee replacement surgery were randomly assigned to receive either general anesthesia (ITN) or combined spinal/epidural anesthesia (CSE). Samples of venous blood were taken from the patients before and after induction of anesthesia, immediately, 6 hours, 24 hours, and 48 hours after surgery. All blood samples were incubated in presence or absence of LPS (lipopolysaccharide; 1 µg/ml) for 24 hours. CD14 and HLA-DR expression patterns on monocytes and intracellular TNF-alpha production were quantified via flow cytometry. TNF-α and IL-10 release were measured via enzyme linked immunosorbent assay (ELISA).

Official Title
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Neuraxial Versus General Anesthesia for Total Knee Replacement Surgery - Are There Different Effects on the Immune System?

Conditions
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Regional Anesthesia, General Anesthesia, Immune Function

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Total knee replacement surgery 18 years or older Exclusion Criteria: clinical signs of infection, neoplasia treatment with immunomodulatory agents any kind of immune mediated disease.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| neuraxial anesthesia<br>Patients with total knee replacement surgery having neuraxial anesthesia along with the procedure. | |
| general anesthesia<br>Patients with total knee replacement surgery having General anesthesia along with the procedure. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| CD 14 and HLA-DR Expression Patterns on monocytes | CD 14 and HLA-DR Expression Patterns on monocytes in whole blood culture assay | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intracellular TNF-alpha production | Intracellular TNF-alpha production in whole blood culture assay | 1 year | 
| TNF-alpha and IL-10 release | TNF-alpha and IL-10 release in whole blood culture assay | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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anesthesia, general anesthesia, neuraxial anesthesia, monocyte funtion, CD 14, HLA-DR, Interleukines