Does isoflurane anesthesia alter immuno-modulatory response in schistosomal patients? Assessment of serum pro- and anti-inflammatory cytokine balance.

Immune system dysfunction in the perioperative period, with its combined pro-inflammatory and immuno-suppressive effects, can influence long term disease progression, morbidity, and mortality. Literature on postoperative immune response in schistosomiasis patients is scarce. The aim of this study was to assess the impact of isoflurane anesthesia on pro- and anti-inflammatory cytokine balance in schistosomal patients undergoing minor procedures. The study was conducted on 24 patients (ASA class I-II) scheduled for elective urologic endoscopic procedures. Patients were divided into two groups 12 patients each: control group (n=12) and patient group (n=12). Anaesthesia was induced by a bolus dose of sufentanil 0.2 microg x kg(-1), thiopentone sodium 5 mg x kg(-1), vecuronium 0.1 mg x kg(-1) and maintained by isoflurane 1-1.5 MAC with additional sufentanil bolus of 0.15 microg x kg(-1) when indicated. Venous blood samples were obtained from each patient: before induction, fifteen minutes, one hr after induction and 24 hrs after surgery. Plasma levels of IL-1beta, TNF-alpha, IL-8, IFN-gamma, IL-1ra and TNF-BP1, as well as stress hormones (cortisol and prolactin) were measured. As for pro- and anti-inflammatory cytokine balance, the overall end-result was a rise at 24 hr postoperatively, in the level of TNF-alpha (a key pro-inflammatory cytokine) and IFN-gamma, as well as both anti-inflammatory cytokines (IL-Ira & sTNF-R1). The anti-inflammatory response was more conspicuous in the patients than controls.