THE PERIOPERATIVE CYTOKINE RESPONSE IN INFANTS AND YOUNG-CHILDREN FOLLOWING MAJOR SURGERY

The peri-operative cytokine response was studied in 13 infants and you ng children undergoing major surgery. All children were anaesthetized with a combined general and epidural anaesthetic technique, followed b y post-operative epidural analgesia with bupivacaine and fentanyl. Blo od samples were taken before and after surgery, 24 h post-operatively, and finally, when the children were mobilized and had regained gastro intestinal function. Plasma samples were analysed for tumour necrosis factor-alpha, interleukin-1 alpha, interleukin-1 beta, interleukin-6, interferon-gamma, interleukin-10 and the interleukin-1 receptor antago nist. The cytokine responses were highly variable. Overall, no signifi cant changes between pre-and post-operative plasma concentrations were found. Tumour necrosis factor-ct and the interleukin-1 receptor antag onist were detectable in all children, and a trend towards an early in crease in the interleukin-1 receptor antagonist levels at the end of s urgery was seen. The other cytokines were only detectable at low conce ntrations among a minority of children. In conclusion, this study show ed highly variable peri-operative cytokine responses in infants and yo ung children undergoing major surgery.