Inflammatory response in patients undergoing colorectal cancer surgery: the effect of two different anesthetic techniques

Abstract

Background: Anesthesia during surgery often induces an inflammatory response. The aim of this study was to establish and compare differences in inflammatory response among colorectal cancer surgery patients receiving either total intravenous anesthesia (TIVA) with propofol and remifentanil or inhalational anesthesia (INHAL) with sevoflurane and fentanyl.

Methods: After randomization, we included fifty consecutive patients undergoing colorectal cancer surgery in our study. TIVA patients received total intravenous anesthesia with propofol and remifentanil, while INHAL patients received inhalation anesthesia with sevoflurane in O2/air and fentanyl. Plasma concentrations of IL-8, IL-17, MPO, ICAM-1, V-CAM and L-selectin were quantified. Blood loss, body temperature and blood glucose levels were measured in patients both before and after surgery.

Results: In both groups, levels of IL-8, MPO, ICAM-1 and L-selectin decreased 60 min after the start of surgery (P<0.05, P<0.01, respectively) and 30 min post-surgery (P<0.05 for both groups). In the INHAL group, V-CAM levels were significantly lower 60 min after the start of surgery (P<0.01) and 30 min post-surgery (P<0.05). At 24 h post-surgery, V-CAM levels were significantly higher in both groups (P<0.01), while IL-17 levels significantly increased only in the INHAL group (P<0.05). Higher blood glucose levels were also observed in the INHAL group compared to that in the TIVA group (P<0.01).

Conclusion: TIVA with propofol and remifentanil and INHAL with sevoflurane and fentanyl induced similar inflammatory responses during colorectal cancer surgery. We found that IL-17 cytokine levels were higher in patients anesthetized with sevoflurane and fentanyl.