Upregulation of IFN-gamma and soluble interleukin-2 receptor release and altered serum cortisol and prolactin concentration during general anesthesia

The effects of surgery, surgical stress, and anesthesia compromise the opti mal function of the immune system. Recent studies demonstrate the influence of anesthesia on the immune response by modulation of neural-immune intera ctions. To evaluate the immunologic effects of general anesthesia with the hypnotic agent propofol and the opioid fentanyl, two drugs used frequently in anesthesia, we studied 30 patients undergoing elective orthopedic surger y before and during narcosis. We found a significant enhancement of interfe ron-gamma (IFN-gamma) and soluble interleukin-2 receptor (sIL-2R) release i n lipopolysaccharide (LPS)-stimulated whole blood cultures after induction of anesthesia. Similar results were observed in cultures stimulated with po lyclonal T cell activators, such as staphylococcal enterotoxin B (SEB) and phytohemagglutinin (PHA). IL-1 beta and IL-8 release was not affected, but the anti-inflammatory cytokine IL-10 decreased after skin incision. Serum p rolactin significantly increased immediately after induction of anesthesia, whereas serum cortisol levels declined. Our results point to enhanced proi nflammatory T lymphocyte and natural killer (NK) cell activity, probably ca used by prolactin and cortisol modulation in the serum. This may disturb th e balance of human proinflammatory and anti-inflammatory pathways during su rgery and general anesthesia.