Effects of general and spinal anesthetic techniques on endothelial adhesion molecules in cesarean section

다국어 초록 (Multilingual Abstract)

Background: The aim of this study was to investigate the effects of anesthetic techniques used during general anesthesia (GA) and spinal anesthesia (SA) on endothelial adhesion molecules in the fetal circulation of healthy parturients undergoing elective cesarean section.
Methods: Patients were randomly assigned to either the general anesthesia (n = 20) or spinal anesthesia (n = 20) group. Maternal and cord blood neopterin, sE-selectin, and sL-selectin levels were measured in both groups.
Results: Cord blood neopterin concentrations in the SA group were not different from those in the GA group, but maternal neopterin levels in the SA group were different from those in the GA group. Maternal blood levels of sE-selectin and sL-selectin were not different between the two groups. Similarly, the cord blood levels of sE-selectin and sL-selectin were not different between the two groups. We found an increased inflammatory process in the fetal circulation depending on the anesthetic method used.
Conclusions: These results indicate the effects of general and spinal anesthetic techniques on serum sL-selectin, sE-selectin, and neopterin levels in neonates and parturients undergoing elective cesarean section. sE-selectin and neopterin concentrations and leukocyte counts were higher in the fetal circulation than in the maternal circulation during both GA and SA.

참고문헌 (Reference)

1 Wicherek L, "The possible correlation between the patient's immune tolerance level during cesaerean section and the incidence of subsequent emergency peripartum hysterectomy" 2007 : 63596-, 2007

2 De Jongh RF, "The influence of anaesthetic techniques and type of delivery on peripartum serum interleukin-6 concentrations" 41 : 853-860, 1997

3 Biao Z, "The in vitro effect of desflurane preconditioning on endothelial adhesion molecules and mRNA expression" 100 : 1007-1013, 2005

4 De Jongh RF, "The fetomaternal dependency of cord blood interleukin-6" 16 : 121-128, 1999

5 Cakir E, "The association between neopterin and acetaminophen-induced nephrotoxicity" 32 : 740-746, 2010

6 Emmett RS, "Techniques for preventing hypotension during spinal anaesthesia for caesarean section" (3) : CD002251-, 2002

7 Ng K, "Spinal versus epidural anaesthesia for caesarean section" (2) : CD003765-, 2004

8 Newman W, "Soluble E-selectin is found in supernatants of activated endothelial cells and is elevated in the serum of patients with septic shock" 150 : 644-654, 1993

9 Kansas GS, "Selectins and their ligands: current concepts and controversies" 88 : 3259-3287, 1996

10 Naito Y, "Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery" 77 : 426-431, 1992

11 Volk T, "Postoperative epidural anesthesia preserves lymphocyte, but not monocyte, immune function after major spine surgery" 98 : 1086-1092, 2004

12 Hammerer-Lercher A, "Possible placental exchange of neopterin as indicated by significant correlations in matched maternal neonatal blood samples at delivery" 365 : 350-351, 2006

13 Müller MM, "Neopterin in clinical practice" 201 : 1-16, 1991

14 Douglas RG, "Metabolic response to sepsis and trauma" 76 : 115-122, 1989

15 Gyarmati B, "Maternal cytokine balance on the third postpartum day is not affected by the mode of delivery after healthy pregnancies" 38 : 208-213, 2010

16 Hall GM, "Interleukin-6 and the metabolic response to surgery" 69 : 337-338, 1992

17 Catarino C, "Inflammatory disturbances in preeclampsia: relationship between maternal and umbilical cord blood" 2012 : 684384-, 2012

18 Sood R, "Fetomaternal cross talk in the placental vascular bed: control of coagulation by trophoblast cells" 107 : 3173-3180, 2006

19 Osman I, "Expression and localization of cell adhesion molecules in human fetal membranes during parturition" 63 : 11-21, 2004

20 Coskun O, "Evaluating the validity of serum neopterin and chitotriosidase levels in follow-up brucellosis patients" 49 : 1111-1118, 2010

21 Arzola C, "Efficacy of low-dose bupivacaine in spinal anaesthesia for Caesarean delivery: systematic review and metaanalysis" 107 : 308-318, 2011

22 Shimada M, "Effect of anesthesia and surgery on plasma cytokine levels" 8 : 109-116, 1993

23 Carvalho B, "Continuous subcutaneous instillation of bupivacaine compared to saline reduces interleukin 10 and increases substance P in surgical wounds after cesarean delivery" 111 : 1452-1459, 2010

24 Jadon A, "Complications of regional and general anaesthesia in obstetric practice" 54 : 415-420, 2010

25 Gearing AJ, "Circulating adhesion molecules in disease" 14 : 506-512, 1993

26 Mellembakken JR, "Chemokines and leukocyte activation in the fetal circulation during preeclampsia" 38 : 394-398, 2001

27 Høgevold HE, "Changes in plasma IL-1beta, TNF-alpha and IL-6 after total hip replacement surgery in general or regional anaesthesia" 12 : 1156-1159, 2000

28 Järvisalo MJ, "Assessment of inflammatory markers and endothelial function" 9 : 547-552, 2006

29 Haught WH, "Alterations in circulating intercellular adhesion molecule-1 and L-selectin: further evidence for chronic inflammation in ischemic heart disease" 132 : 1-8, 1996

30 Blankenberg S, "Adhesion molecules and atherosclerosis" 170 : 191-203, 2003