Immune Responses of Healthy Pregnant Women following an Elective Cesarean Section: Effects of Anesthetic Procedures

Abstract

A weakened immune system and more inflammatory cytokines being released are possible effects of the surgical stress that a cesarean section induces. This kind of reaction, in addition to the altered reaction to catecholamines, has the potential to significantly affect the immune system of the mother and the patients' general postoperative course. This prospective study compared the plasma levels of catecholamines and cytokines in healthy pregnant patients having cesarean sections under spinal anesthesia versus general anesthesia. A total of 30 pregnant women undergoing elective cesarean sections were divided into two groups: 15 who received general anesthesia (GA) and 15 who received spinal anesthesia (SA). Blood samples were collected from all subjects before anesthesia induction (pre-OP), 6 h postoperatively (6 h post-OP), and 12 h (12 h post-OP), to measure levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-8, IL-4, IL-10, norepinephrine (NE), and epinephrine (EPI). When we compared the two groups, we discovered that only IL-6 and IL-4 had significantly higher levels pre-OP, whereas all studied cytokines exhibited an increase in the GA versus SA group at 6 and 12 h post-OP. In the case of catecholamines, we discovered that serum levels are positively related with pro-inflammatory or anti-inflammatory cytokines, depending on the time of day and type of anesthetic drugs. Compared to SA, GA has a more consistent effect on the inflammatory response and catecholamine levels. The findings of this study confirm that the type of anesthesia can alter postoperative immunomodulation to various degrees via changes in cytokine and catecholamine production. SA could be a preferable choice for cesarean section because it is an anesthetic method that reduces perioperative stress and allows for less opioid administration, impacting cytokine production with proper immunomodulation.

Keywords: catecholamines; cytokines; general anesthesia; immune response; spinal anesthesia.

Figure 1

Flow diagram with patients included.

Figure 2

Correlation heatmap matrix between measured catecholamines and cytokines (colours ranging from brilliant red for strong negative correlations to bright green for strong positive correlations) in GA group: (A) At 6 h post-OP time, and (B) at 12 h post-OP time. TNF-α: tumor necrosis factor-alpha; IL: interleukin; NE: norepinephrine; EPI: epinephrine.

Figure 3

Correlation heatmap matrix between measured catecholamines and cytokines (colours ranging from brilliant red for strong negative correlations to bright green for strong positive correlations) in SA group: (A) At 6 h post-OP time, and (B) at 12 h post-OP time. TNF-α: tumor necrosis factor-alpha; IL: interleukin; NE: norepinephrine; EPI: epinephrine.