Betül BAHADIR, Elif BAŞGÜL, Varol ÇELİKER, Heves KARAGÖZ, Ülkü AYPAR

Halotan, izofluran ve sevofluran anestezlerinin immün yanıta etkisi

Bu çalışmanın amacı halotan, izofluran ve sevofluran anestezilerinin immün yanıta etkisini karşılaştırmaktır. Çalımaya ASA I-II grubu, laparaskopik kolesistektomi yapılacak, 30-60 yaş arasında 35 hasta dahil edildi. Hastalar randomize olarak 3 gruba ayrıldı (halotan n:12, izofluran n:12, sevofluran n:11). Tiyopental, veküronyum ve fentanil ile indüksiyonu takiben, anestezi idamesi kontrollü ventilasyon ile % 50 - % 50 N2O - oksijen ve volatil ajanlardan biri ile [I. Grupta halotan (Grup H), II. Grupta izofluran (Grup İ) ve III. Grupta sevofluran (Grup S) ] sağlandı. İndüksiyon öncesi, insizyon öncesi, operasyon bitimi ve postoperatif 24. saatlerde venöz kan örnekleri alınarak serum IL-2, IL-6, IgA, IgG ve IgM, düzeylerine bakıldı. immünolojik parametrelerin zamana bağlı değişimi her üç grupta da benzerdi. Serum IgA, IgG ve IgM düzeylerinde her üç grupta da indüksiyon öncesi değere oranla insizyon öncesinde ve cerrahi sonunda düşüş saptanırken, IL-2 değerleri sadece insizyon öncesi bütün gruplarda belirgin olarak düşmüştür. Serum IL-6 düzeylerinde ise 24. saatte en fazla olmak üzere indüksiyondan sonra belirgin artış görüldü. Sonuç olarak immün sistemdeki bu baskılanmanın halotan, izofluran ve sevofluranın etkisinden çok cerrahi travmaya verilen nöroendokrin yanıta bağlı olduğu ve üç volatil ajan arasında immün yanıt açısından fark olmadığı kanısına varıldı.

Anahtar Kelimeler:

IgA, Halotan, İnterlökin-6, İnterlökin-2, İzofluran, IgM, IgG, Anestezikler, inhalasyon

The effects of Halothane, isoflurane and sevoflurane anesthesia on immune response

The aim of this study was to compare the effects of halothane, isoflurane and sevoflurane on immune response. 35 patients ASA grade I-II scheduled to undergo laparoscopic cholecystectomy were included in the study. Patients were randomly allocated into three groups according to the inhalation agents used (halothane n:12, isoflurane n:12, sevoflurane n:11). In all groups, general anesthesia was induced with thiopentone, vecuronium and fentanyl and maintained with 50 % N2O in oxygen and one of the three volatile agents [Group I: halothane (Group H), Group II: isoflurane (Group I) and Group III: sevoflurane (Group S)]. Blood samples were taken before induction and skin incision, at the end of surgery and, 24 hours postoperatively, to determine serum IgA, IgG, IgM, IL-2 and IL-6 levels. The changes in immunologic parameters according to time were similar in all groups. Serum IgA, IgG and IgM levels showed a significant decrease before incision and at the end of surgery where serum IL-2 levels showed a significant decrease before incision in all groups. Serum IL-6 levels showed a significant increase after surgery and 24 hours postoperatively in all groups. As a result, this significant immune supression was thought to be the primary effect of surgical trauma rather than the effect of halothane, isoflurane and sevoflurane and these three volatil anesthetics had basically similar effects on serum immunoglobulin and cytokine levels.

Keywords:

IgA, Halothane, Interleukin-6, Interleukin-2, Isoflurane, IgM, IgG, Anesthetics, Inhalation,

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