Abstract
The purpose of this study was to compare neutrophil cidal activity during general or spinal anaesthesia. Assays were performed on neutrophils extracted from the blood of patients after surgery had been under way for one hour. First, the ability of the neutrophils to kill a standard laboratory strain of S. aureus was examined. Neutrophils extracted from the blood during surgery in the spinal anaesthetic group and incubated with the staphylococci for one hour killed twice as many bacteria than those from two groups of patients that received halothane or isoflurane general anaesthesia (P < 0.05). This effect persisted, to a lesser extent, in the spinal group neutrophils after two hours of incubation with the bacteria. Second, neutrophils from patients under the same conditions of surgery and anaesthesia were tested to examine the effect of the different anaesthetic techniques on neutrophil biocidal mechanisms. Neutrophils extracted during surgery in the spinal group released more superoxide in response to phorbol-12-myristate-13-acetate (PMA) than those from both groups of patients that received general anaesthesia (P < 0.05). It is concluded that there is an increased state of reactivity of the neutrophil cell membrane NADPH oxidase system in patients receiving spinal anaesthesia than in patients receiving general anaesthesia.
Résumé
Cette étude vise à comparer l’activité bactéricide des neutrophiles pendant l’anesthésie générale ou rachidienne. Les analyses sont effectuées à partir de neutrophiles extraits du sang de patients une heure après le début de la chirurgie. D’abord, l’habileté des neutrophiles à tuer une colonie standard de S. aureus est éxaminée. Les neutrophiles extraits de patients sous rachianesthésie et incubés avec des neutrophiles pendant une heure tuent deux fois plus de bactéries que le sang se patients sous anesthésie générale à l’halothane ou à l’isoflurane (P < 0,05). Cet effet persiste, mais à un degré moindre, dans le sang du groupe rachianesthésie après un contact de deux heures avec les bactéries. Ensuite, on a examiné sous les mêmes conditions d’anesthésie et de chirurgie les neutrophiles de patients anesthésiés avec les différentes techniques pour en déterminer le mécanisme bactéricide. Les neutrophiles extraits pendant la rachianesthésie libèrent plus de superoxyde en réponse au phorbol-12-myristate-13-acétate (PMA) que ceux des deux groupes de patients sous générale (P < 0,05). En conclusion, on constate une augmentation de l’état réactif du système NADPH oxydase de la membrane cellulaire du neutrophile chez les patients sous rachianesthésie comparativement à ceux qui sont sous anesthésie générale.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Erskine R, Janicki PK, Ellis P, James MFM. Neutrophils from patients undergoing hip surgery exhibit enhanced movement under spinal anaesthesia compared with general anaesthesia. Can J Anaesth 1992; 39: 905–10.
Easmon C. The nature of host defences. In: Pollack A (Ed.). Surgical Infections, 1st ed. New York: Edward Arnold 1989; 25–35.
Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high risk surgical patients. Anesthesiology 1987; 66: 729–36.
Anand KJS, Hickey PR. Halothane-morphine compared with high dose sufentanil for anesthesia and postoperative analgesia in neonatal cardiac surgery. N Engl J Med 1992; 326: 1–9.
Nakagawara M, Takeshiga K, Takamatsu J, Takahashi S, Yoshitake J, Minakame S. Inhibition of superoxide production and Ca2+ mobilization in human neutrophils by halothane, enflurane and isoflurane. Anesthesiology 1986; 64: 4–12.
Welch WD. Effect of halothane and N2O on the oxidative activity of human neutrophils. Anesthesiology 1982; 57: 172–6.
Welch WD. Effect of enflurane, isoflurane, and nitrous oxide on the micro-biocidal activity of human polymorphonuclear leukocytes. Anesthesiology 1984; 61: 188–92.
Tsuchiya M, Okimasu E, Ueda W, Hirakawa M, Utsumi K. Halothane, an inhalation anesthetic, activates protein kinase C and superoxide generation by neutrophils. FEBS Lett 1988; 242: 101–5.
Welch WD Halothane reversibly inhibits human neutrophil bacterial killing. Anesthesiology 1981; 55: 650–4.
Bardosi L, Tekeres M. Impaired metabolic activity of phagocytic cells after anaesthesia and surgery. Br J Anaesth 1985; 57: 520–3.
Busoni P, Sarti A, De Martino M, Graziani E, Santoro S. The effect of general and regional anesthesia on oxygendependent microbicidal mechanisms of polymorphonuclear leukocytes in children. Anesth Analg 1988; 67: 453–6.
Heberer M, Zbinden AM, Ernst M, Durig M, Harder F. The effect of surgery and anesthetic agents on granulocytechemiluminescence in whole blood. Experientia 1985; 41: 342–6.
Cullen BF, Hume RB, Chretien PB. Phagocytosis during general anesthesia in man. Anesth Analg 1975; 54: 501–4.
Mealy K, O’Farrelly C, Stephens R, Feighery C. Impaired neutrophil function during anesthesia and surgery is due to serum factors. J Surg Res 1987; 43: 393–7.
Barth J, Petermann W, Entzian P, Wustrow C, Wustrow J, Ohnhaus EE. Modulation of oxygen-free radicals from human leukocytes during halothaneand enflurane-induced general anesthesia. Acta Anaesthesiol Scand 1987; 31: 740–3.
MacKenzie N, Grant IS. Propofol for intravenous sedation. Anaesthesia 1987; 42: 3–6.
Haddad HL, Beatty DW, Dowdle EB. Chronic granulomatous disease of childhood. S Afr Med J 1976; 50: 2068–72.
Weiss SJ. Tissue destruction by neutrophils. N Engl J Med 1989; 320: 365–76.
Brandt M, Kehlet H, Binder C, Hagen C, McNeilly AS. Effect of epidural analgesia on the glycoregulatory endocrine response to surgery. Clin Endocrinol 1976; 5: 107–14.
Cooper GM, Holdcroft A, Hall GM, Alaghband-Zadeh J. Epidural analgesia and the metabolic response to surgery. Can Anaesth Soc J 1979; 26: 381–5.
Moudgil GC. Effect of premedicants, intravenous anaesthetic agents and local anaesthetics on phagocytosisin vitro. Can Anaesth Soc J 1981; 28: 597–602.
Hirata F, Schiffmann E, Venkatasubramanian K, Salomon D, Axelrod J. A phospholipase A2 inhibitory protein in rabbit neutrophils induced by gluco-corticoids. Proc Natl Acad Sci USA 1980; 77: 2533–6.
Blackwell G, Carnuccio R, Di Rosa M, Flower RJ, Parente L, Percio P. Macro-cortin: a polypeptide causing the anti-phospholipase effect of glucocorticoids. Nature 1980; 287: 147–9.
Hallet MB, Campbell AK. Two distinct mechanisms for stimulation of oxygen-radical production by polymorphonuclear leukocytes. Biochem J 1983; 216: 459–65.
Hosker HSR, Kelly C, Corris PA. Assessment of phagocytic function using chemiluminescence. Blood Rev 1989; 3: 88–93.
Allen RC. Phagocytic leukocyte oxygenation activities and chemiluminescence: a kinetic approach to analysis. Methods Enzymol 1986; 133: 449–93.
Author information
Authors and Affiliations
Additional information
Supported by the Anglo American Corporation, The Arthritis Foundation of South Africa and the Ethical Research Committee of the University of Cape Town.
Rights and permissions
About this article
Cite this article
Erskine, R., Janicki, P.K., Neil, G. et al. Spinal anaesthesia but not general anaesthesia enhances neutrophil biocidal activity in hip arthroplasty patients. Can J Anaesth 41, 632–638 (1994). https://doi.org/10.1007/BF03010005
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03010005