Abstract
Purpose
Patients with severe brain injury often require long-term sedation and have a high incidence of nosocomial infections, causing an increased mortality rate. However, whether anesthetic drugs might contribute to immunosuppressive effects remains unclear.
Methods
In this prospective study, we investigated the effects of propofol (4–6 mg·kg−1·h−1) and methohexital (1–3 mg·kg−1·h−1) on neutrophil leukocyte function and immune status in 21 patients with brain injury who either received propofol (n = 12; 9 male, 3 female; mean age, 51 ± 15 years) or methohexital (n = 9; 8 male, 1 female; mean age, 48 ± 17 years) after admission to the intensive care unit (ICU). Both sedatives were administered over 7 days and individual dosage was adapted according to clinical requirements. Neutrophil leukocyte function was assessed as phagocytosis and respiratory oxidative burst activity. Furthermore, leukocyte subpopulations, and surface markers of lymphocytes and monocytes (CD3; CD4; CD45RO; CD4/CD45RO; CD25; CD4 and CD25; CD54; CD69; CD14/HLA-DR; CD8; CD3/HLA-DR; CD4 : CD8 ratio) were assessed. Blood samples were drawn on ICU admission, and on days 3, 7, and 14. Patients' demographics were compared by Wilcoxon test and laboratory results were compared by analysis of variance (ANOVA) for repeated measurements, with an all pairwise multiple comparison procedure.
Results
There were no significant differences in neutrophil oxidative burst and phagocytosis within or between the two groups at the different time points. With respect to cellular markers of lymphocytes and monocytes, all values throughout remained in the normal range.
Conclusion
Methohexital and propofol exhibited no significant effects on neutrophil function and immune status in patients with severe brain injury requiring long-term sedation.
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References
D Frohlich G Rothe B Schwall G Schmitz J Hobbhahn K Taeger (1996) ArticleTitleThiopentone and propofol, but not methohexitone nor midazolam, inhibit neutrophil oxidative responses to the bacterial peptide FMLP Eur J Anaesthesiol 13 582–588 Occurrence Handle10.1046/j.1365-2346.1996.d01-405.x Occurrence Handle1:STN:280:ByiC3MjksFY%3D Occurrence Handle8958489
J Heine M Leuwer D Scheinichen L Arseniev K Jaeger S Piepenbrock (1996) ArticleTitleFlow cytometry evaluation of the in vitro influence of four i.v. anaesthetics on respiratory burst of neutrophils Br J Anaesth 77 387–392 Occurrence Handle1:CAS:528:DyaK28XmtF2nurs%3D Occurrence Handle8949817
M Weiss R Buhl M Medve EM Schneider (1997) ArticleTitleTumor necrosis factor-alpha modulates the selective interference of hypnotics and sedatives to suppress N-formyl-methionyl-leucyl-phenylalanine-induced oxidative burst formation in neutrophils Crit Care Med 25 128–134 Occurrence Handle1:STN:280:ByiC2czhslM%3D Occurrence Handle8989188
M Weiss R Buhl A Birkhahn N Mirow M Schneider P Wernet (1994) ArticleTitleDo barbiturates and their solutions suppress FMLP-induced neutrophil chemiluminescence? Eur J Anaesthesiol 11 371–379 Occurrence Handle1:STN:280:ByqD1c%2FislU%3D Occurrence Handle7988581
JA Davidson SJ Boom FJ Pearsall P Zhang G Ramsay (1995) ArticleTitleComparison of the effects of four i.v. anaesthetic agents on polymorphonuclear leucocyte function Br J Anaesth 74 315–318 Occurrence Handle1:CAS:528:DyaK2MXkvFyls7s%3D Occurrence Handle7718379
PG Murphy AJ Ogilvy SM Whiteley (1996) ArticleTitleThe effect of propofol on the neutrophil respiratory burst Eur J Anaesthesiol 13 471–473 Occurrence Handle10.1046/j.1365-2346.1996.00003.x Occurrence Handle1:CAS:528:DyaK28XmsFWnsbs%3D Occurrence Handle8889420
J Heine K Jaeger A Osthaus N Weingaertner S Munte S Piepenbrock M Leuwer (2000) ArticleTitleAnaesthesia with propofol decreases FMLP-induced neutrophil respiratory burst but not phagocytosis compared with isoflurane Br J Anaesth 85 424–430 Occurrence Handle1:CAS:528:DC%2BD3cXmvFKnurs%3D Occurrence Handle11103185
B Larsen G Hoff W Wilhelm H Buchinger GA Wanner M Bauer (1998) ArticleTitleEffect of intravenous anesthetics on spontaneous and endotoxin-stimulated cytokine response in cultured human whole blood Anesthesiology 89 1218–1227 Occurrence Handle10.1097/00000542-199811000-00023 Occurrence Handle1:CAS:528:DyaK1cXns1elsLg%3D Occurrence Handle9822011
R Koeniger B Landauer (1993) ArticleTitlePneumonie und Multiorganversagen unter Barbiturattherapie bei polytraumatisierten Patienten mit Schädel-Hirn-Verletzungen Intensiv- & Notfallbehandlung 18 165–170
KEW Eberhardt BM Thimm A Spring WR Maskos (1992) ArticleTitleDose-dependent rate of nosocomial pulmonary infection in mechanically ventilated patients with brain edema receiving barbiturate: a prospective case study Infection 20 12–18 Occurrence Handle10.1007/BF01704886 Occurrence Handle1:STN:280:By2B38rmsVw%3D Occurrence Handle1563806
G Rothe A Emmendorffer A Oser J Roesler G Valet (1991) ArticleTitleFlow cytometric measurement of the respiratory burst activity of phagocytes using dihydrorhodamine 123 J Immunol Methods 8 133–135
A Skoutelis P Lianou E Papageorgiou K Kokkinis K Alexopoulos H Bassaris (1994) ArticleTitleEffects of propofol and thiopentone on polymorphonuclear leukocyte functions in vitro Acta Anaesthesiol Scand 38 858–862 Occurrence Handle1:CAS:528:DyaK2MXjs1yrur8%3D Occurrence Handle7887111
K Mikawa H Akamatsu K Nishina M Shiga N Maekawa H Obara Y Niwa (1998) ArticleTitlePropofol inhibits human neutrophil functions Anesth Analg 87 695–700 Occurrence Handle1:CAS:528:DyaK1cXmtVahsLk%3D Occurrence Handle9728856
J Zhao B Juettner D Scheinichen K Jaeger J Heine S Piepenbrock (2003) ArticleTitleRespiratory burst activity of polymorphonuclear cells is dependent on the cell preparation technique Acta Anaesthesiol Scand 47 702–706 Occurrence Handle10.1034/j.1399-6576.2003.00121.x Occurrence Handle1:STN:280:DC%2BD3s3ns1yruw%3D%3D Occurrence Handle12803587
T Inada S Taniuchi K Shingu Y Kobayashi J Fujisawa S Nakao (2001) ArticleTitlePropofol depressed neutrophil hydrogen peroxide production more than midazolam, whereas adhesion molecule expression was minimally affected by both anesthetics in rats with abdominal sepsis Anesth Analg 92 437–441 Occurrence Handle1:CAS:528:DC%2BD3MXht1Sqtrw%3D Occurrence Handle11159247
M Weiss A Birkhahn M Krone EM Schneider (1996) ArticleTitleDo etomidate and propofol influence oxygen radical production of neutrophils? Immunopharmacol Immunotoxicol 18 291–307 Occurrence Handle1:CAS:528:DyaK28XjvV2hu7o%3D Occurrence Handle8771372
D Frohlich S Wittmann G Rothe G Schmitz K Taeger (2002) ArticleTitleThiopental impairs neutrophil oxidative response by inhibition of intracellular signalling Eur J Anaesthesiol 19 474–482 Occurrence Handle1:CAS:528:DC%2BD38XmtFyrt7s%3D Occurrence Handle12113609
J Muhling M Fuchs A Sablotzki M Krull HP Ogal S Weiss MG Dehne J Engel G Hempelmann (2001) ArticleTitleMethohexital affects neutrophil (PMN) dynamic free amino acid pool and immune functions in vitro Eur J Anaesthesiol 18 366–376 Occurrence Handle10.1046/j.0265-0215.2000.00847.x Occurrence Handle1:CAS:528:DC%2BD3MXkvVOjurk%3D Occurrence Handle11412289
W Krumholz H Weidenbusch T Menges G Keller G Hempelmann (2001) ArticleTitleThe influence of intravenous anaesthetics on the activity of enzymes released from polymorphonuclear leucocytes in vitro Eur J Anaesthesiol 18 151–158 Occurrence Handle10.1046/j.0265-0215.2000.00791.x Occurrence Handle1:CAS:528:DC%2BD3MXis1CjsLY%3D Occurrence Handle11298173
CO Pirttikangas M Salo O Peltola (1996) ArticleTitlePropofol infusion anaesthesia and the immune response in elderly patients undergoing ophthalmic surgery Anaesthesia 51 318–323 Occurrence Handle1:CAS:528:DyaK2sXkvVektw%3D%3D Occurrence Handle8686816
CO Pirttikangas M Salo M Mansikka J Gronroos K Pulkki O Peltola (1995) ArticleTitleThe influence of anaesthetic technique upon the immune response to hysterectomy. A comparison of propofol infusion and isoflurane Anaesthesia 50 1056–1061 Occurrence Handle1:STN:280:BymC3sjnslA%3D Occurrence Handle8546287
T Loop Z Liu M Humar A Hoetzel A Benzing HL Pahl KK Geiger BH J Pannen (2002) ArticleTitleThiopental inhibits the activation of nuclear factor kappaB Anesthesiology 96 1202–1213 Occurrence Handle10.1097/00000542-200205000-00025 Occurrence Handle1:CAS:528:DC%2BD38Xkt1Cku7g%3D Occurrence Handle11981162
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Huettemann, E., Jung, A., Vogelsang, H. et al. Effects of propofol vs methohexital on neutrophil function and immune status in critically ill patients. J Anesth 20, 86–91 (2006). https://doi.org/10.1007/s00540-005-0377-2
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DOI: https://doi.org/10.1007/s00540-005-0377-2