Lai Baitang, Ling Guofen, Ruan Shutian (Beijing Tuberculosis Research Institute)
An understanding of the interelationship of immune reaction with anaesthesia and operation is important both to the patients and anesthetists. Postoperative infection, tumor growth, anaphylaxis and response to organ transplantation all may be effected by general anesthesia. In this work, the effect of general anesthesia on peripheral leukocyte count, neutrophilic phagocytosis of B subtilis, lymphocyte transformation and E rosette formation are compared with those of patients with acupuncture anesthesia.
11 patients undergoing chest surgery were induced by Na-thiopental, succinylcholine, then followed by combined anesthesia of intravenous drip of 1% procaine and fluothane inhalation, while acupuncture anesthesia by electric stimulation or hand needling of Sanyangluo point was carried out on 15 patients. Three samples of venous blood were collected from every patients in the operating room before induction and intubation, under anesthesia just prior to incision, and one hour after incision of the skin.
All the immune responses observed were depressed in patients with general anesthesia (during anesthesia and operation). The average leukocyte count of 11 patients was reduced from 9186/mm{3} preoperatively to 7064/mm{3} during anesthesia (p<0.010), but returned to control values in the third sample. The capacity of phagocytosis with B subtilis (i.e. the average number of bacilli phagocytized per 100 neutrophiles) was 25.5 preoperatively but was reduced to 19.6 and 17.6 in the 2nd, 3rd samples (p<0.05) respectively. The percentage of depression is 23% and 31%. The phagocytic index (i.e. the average number of bacilli phagocytised per neutrophile) was 0.849 in first control sample but was 0.651 and 0.609 in the 2nd and 3rd samples (p<0.05). The percentage of depression was 23.3% and 28.3% respectively.
In the experiment of lymphocyte transformation induced by PHA, the average number of small lymphycytes transformed into lymphoblast per 100 cells was 46.5 preopratively and reduced to 39.2 and 36.6 in 2nd and 3rd samples (p<0.05), i.e. it was depressed by 15.7% and 21.3%. As regards to rosette cell formation there was no significant difference between the first and the other two samples.
However, there was no significant changes in immune reaction of patients undergoing acupuncture anesthesia. The only distinguishable change was that the neutrophilic phagocytic capacity with B. subtilis reduced during operation. The preoperative value (24.3) was depressed by 16% to 20.4 (p<0.05). The total leukocyte count increased, from the initial value of 7047/mm{3} to 9590/mm{3} during operation (p<0.01).
These results indicate that there was no depression in immune reaction in patients undergoing acupuncture anesthesia, the only effect is reduction of phagocytic capacity of neutrophiles at 1 hour after the beginning of operation. In contrast, in patients undergoing general anesthesia, the mobility of leukocytes, phagocytic activity and lymphocyte transformation were all depressed at the onset of anesthesia and aggravated by operation. Since the changes are slight in degree in both conditions the clinical significance of the depressed immune reaction for the patient undergoing major surgical operation needs further investigation.
An understanding of the interelationship of immune reaction with anaesthesia and operation is important both to the patients and anesthetists. Postoperative infection, tumor growth, anaphylaxis and response to organ transplantation all may be effected by general anesthesia. In this work, the effect of general anesthesia on peripheral leukocyte count, neutrophilic phagocytosis of B subtilis, lymphocyte transformation and E rosette formation are compared with those of patients with acupuncture anesthesia.
11 patients undergoing chest surgery were induced by Na-thiopental, succinylcholine, then followed by combined anesthesia of intravenous drip of 1% procaine and fluothane inhalation, while acupuncture anesthesia by electric stimulation or hand needling of Sanyangluo point was carried out on 15 patients. Three samples of venous blood were collected from every patients in the operating room before induction and intubation, under anesthesia just prior to incision, and one hour after incision of the skin.
All the immune responses observed were depressed in patients with general anesthesia (during anesthesia and operation). The average leukocyte count of 11 patients was reduced from 9186/mm{3} preoperatively to 7064/mm{3} during anesthesia (p<0.010), but returned to control values in the third sample. The capacity of phagocytosis with B subtilis (i.e. the average number of bacilli phagocytized per 100 neutrophiles) was 25.5 preoperatively but was reduced to 19.6 and 17.6 in the 2nd, 3rd samples (p<0.05) respectively. The percentage of depression is 23% and 31%. The phagocytic index (i.e. the average number of bacilli phagocytised per neutrophile) was 0.849 in first control sample but was 0.651 and 0.609 in the 2nd and 3rd samples (p<0.05). The percentage of depression was 23.3% and 28.3% respectively.
In the experiment of lymphocyte transformation induced by PHA, the average number of small lymphycytes transformed into lymphoblast per 100 cells was 46.5 preopratively and reduced to 39.2 and 36.6 in 2nd and 3rd samples (p<0.05), i.e. it was depressed by 15.7% and 21.3%. As regards to rosette cell formation there was no significant difference between the first and the other two samples.
However, there was no significant changes in immune reaction of patients undergoing acupuncture anesthesia. The only distinguishable change was that the neutrophilic phagocytic capacity with B. subtilis reduced during operation. The preoperative value (24.3) was depressed by 16% to 20.4 (p<0.05). The total leukocyte count increased, from the initial value of 7047/mm{3} to 9590/mm{3} during operation (p<0.01).
These results indicate that there was no depression in immune reaction in patients undergoing acupuncture anesthesia, the only effect is reduction of phagocytic capacity of neutrophiles at 1 hour after the beginning of operation. In contrast, in patients undergoing general anesthesia, the mobility of leukocytes, phagocytic activity and lymphocyte transformation were all depressed at the onset of anesthesia and aggravated by operation. Since the changes are slight in degree in both conditions the clinical significance of the depressed immune reaction for the patient undergoing major surgical operation needs further investigation.
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