The perioperative effect of anesthetic drugs on the immune response in total intravenous anesthesia in patients undergoing minimally invasive gynecological surgery

Abstract

Background: The specific mechanism of action of each anesthetic drug on the immune system is still incompletely known. It is important to know how the various anesthetics used in minimally invasive surgery (MIS) act on the inflammatory response because the choice of the anesthetic agent can influence the patient's immune system.

Aim: Evaluation of the effect of anesthetic drugs used for total intravenous anesthesia (Propofol and Midazolam) on the inflammatory response after minimally invasive gynecological surgery.

Patients, materials and methods: The inflammatory response in 20 female patients who underwent minimally invasive gynecological surgery under which intravenous anesthesia was performed. Depending on the combination of anesthetics used, we subdivided the study group into two groups, Group 1 consisting of the patients (n=10) who were given for total intravenous anesthesia, the combination with Midazolam+Fentanyl, and Group 2 (n=10) the patients who received the combination of Propofol+Fentanyl, respectively. Surgical interventional procedures included day surgery: diagnostic and operative hysteroscopy, endometrial ablation, surgical treatment of vulvar disorders. Serological profiling of patients was performed by dosing the serum concentration of nucleotide-binding domain (NOD) and leucine-rich repeat protein 3 (NLRP3) inflammasomes, interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), IL-10 before and two hours after the surgical procedure.

Results: In our study, we found that in both groups of patients (Midazolam+Fentanyl - Group 1, Propofol+Fentanyl - Group 2), NLRP3 and cytokines concentrations in the serum were higher after MIS than those before MIS.

Conclusions: It appears that both Midazolam and Fentanyl and Propofol and Fentanyl have an immunomodulatory action due to the anti-inflammatory effect of both anesthetics. Therefore, anesthesiologists must choose an anesthetic method that uses individualized anesthetic agents, depending on the patient's immune status and disease.

Figure 1

Simple endometrial hyperplasia without atypia with moderate diffuse lymphocytic infiltrate. Hematoxylin–Eosin (HE) staining, ×200

Figure 2

Simple endometrial hyperplasia with atypia. HE staining, ×200

Figure 3

Complex endometrial hyperplasia without atypia, periglandular lymphocyte band. HE staining, ×200

Figure 4

Complex endometrial hyperplasia with atypia, periglandular lymphocytic infiltrates with occasional intraepithelial extension. HE staining, ×200

Figure 5

Well-differentiated endometrioid adenocarcinoma, rich periglandular lymphocytic infiltrate. HE staining, ×100

Figure 6

NLRP3 concentrations in serum of patients who underwent minimally invasive surgery: bar per column represent the concentrations of NLRP3 [ng/mL]; red horizontal lines represent the 95% confidence interval (CI). NLRP3: Nucleotide-binding domain (NOD) and leucine-rich repeat protein 3

Figure 7

TNF-α concentrations in serum of patients who underwent minimally invasive surgery: bar per column represent the concentrations of TNF-α [pg/mL]; red horizontal lines represent the 95% confidence interval (CI). TNF-α: Tumor necrosis factor-alpha

Figure 8

IL-6 concentrations in serum of patients who underwent minimally invasive surgery: bar per column represent the concentrations of IL-6 [pg/mL]; red horizontal lines represent the 95% confidence interval (CI). IL-6: Interleukin-6

Figure 9

IL-10 concentrations in serum of patients who underwent minimally invasive surgery: bar per column represent the concentrations of IL-10 [pg/mL]; red horizontal lines represent the 95% confidence interval (CI). IL-10: Interleukin-10