Modulation of Inflammatory Response in Surgical Trauma

Abstract

Surgical trauma results in the activation of inflammatory cascade systems in the body. Excessive systemic inflammation can lead to organ dysfunction in one or several organs. The thesis aims to describe the body's inflammatory response during major surgery and the extent to which the answer depends on different methods of blood salvage, anesthesia and surgical technique. Method: Twenty-four patients scheduled for total hip arthroplasty were randomized to two groups. Blood was collected via a heparin-coated device or via a non-heparin-coated device. Samples were taken from collected blood to measure quality and inflammatory activation. Fifty consecutive patients who were scheduled for elective open colorectal surgery were included in a prospective and randomized study. The patients were randomized to total intravenous anesthesia with propofol-remifentanil or inhalation anesthesia with sevoflurane. Twenty-four patients with rectal cancer were randomized to open or laparoscopic rectal resection. Blood samples were taken before, during and after surgery for analysis of inflammatory metabolites including cytokines and complement split products. Results: I: IL-6, IL-8, C3a and SC5b-9 were higher in salvaged blood than in venous blood. There were no significant differences between the blood salvaged in the system with heparin-coated surfaces compared to non-heparin-coated surfaces regarding these parameters. II: IL-6, IL-8 and C3a increased during surgery and were elevated compared to baseline in both groups. III: Bb concentrations increased in both groups during surgery. A significant increase in SC5b-9 concentration was seen in both groups in the postoperative period. IV: IL-6, IL-10 and CRP were higher in the open group as compared to the laparoscopic group. Conclusions: Blood salvaged intra-operatively during total hip arthroplasty contains elevated levels of complement split products and pro-inflammatory cytokines. Heparin-coated surfaces of the salvage device do not significantly influence the formation of inflammatory mediators. Major colorectal surgery leads to activation of the complement cascade and the release of both pro-inflammatory and anti-inflammatory cytokines. Complement is activated through the alternative pathway. There are no significant differences between total intravenous anesthesia (TIVA) with propofol and remifentanil and inhalational anesthesia with sevoflurane and fentanyl regarding complement activation and the release of pro- and anti-inflammatory interleukins. Rectal surgery causes release of both pro- and anti-inflammatory cytokines. The inflammatory response is lower in laparoscopic rectal surgery as compared to conventional open surgery.