Urinary neopterin and kynurenine in patients submitted to surgical stress with different inhalational anesthetics (halothane or isoflurane)

Measurements were taken of urinary levels of neopterin (NPT) and kynurenine (KYN), using an HPLC method for their simultaneous analysis in patients su bmitted to anesthetical-surgical stress with two different inhalational ane sthetics (halothane and isoflurane), We studied twenty-one women affected b y uterine fibromyomatosis and submitted to total hysterectomy (mean age of 42.7 +/- 5.4 years). They showed the same pre-operative evaluation (ASA-1), and underwent the same i.v. anesthetic treatment. Our patients were random ized in two groups: Group A: 11 patients had halothane as an inhalational a nesthetic drug for the maintenance of the anesthetic induction (mean time = 1 h). Group B: 10 patients had isoflurane, A significant decrease in urinary NPT and KYN, parallel to serum-NPT, was f ound 4 h after anesthetic induction. Raised NPT levels appeared 24 h after A.I, with significant increased levels after 7 days. A strong correlation b etween urinary and serum NPT levels was seen (Rs = 0.74; p < 0.001). Significantly low KYN levels were observed both 4 h and 24 h after A,I,, In addition to the delayed increase of the excretory KYN levels, significantl y raised KYN levels in Group B (isoflurane) 48 h after A.I. (10.59 +/- 14.3 1 vs 5.99 +/- 7.17 mu mol/mol creat.; p < 0.01) were shown, whereas in Grou p A (halothane) we observed a progressive increase as compared to the pre-s urgery values starting from 72 h after surgery. Our data seem to show that: (a) it is possible to have a biochemical and no n invasive monitoring of the anesthetical-surgical stress on MM "priming" a ctivity; (b) the activation of the phagocyte compartment is one of the earl ier immunological events after surgery (NPT), but the efficiency of this "p riming" appears to be delayed (KYN); (c) isoflurane appears to induce an ea rlier recovery in MM activation. (C) 1999 International Society for Immunop harmacology. Published by Elsevier Science Ltd. All rights reserved.