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The Effects of Perioperative Anesthesia and Analgesia on Immune Function in Patients Undergoing Breast Cancer Resection: A Prospective Randomized Study

Authors
 Jin Sun Cho  ;  Mi-Hyang Lee  ;  Seung Il Kim  ;  Seho Park  ;  Hyung Seok Park  ;  Ein Oh  ;  Jong Ho Lee  ;  Bon-Nyeo Koo 
Citation
 INTERNATIONAL JOURNAL OF MEDICAL SCIENCES, Vol.14(10) : 970-976, 2017 
Journal Title
 INTERNATIONAL JOURNAL OF MEDICAL SCIENCES 
Issue Date
2017
MeSH
Adult ; Aged ; Analgesia/adverse effects* ; Analgesia/methods ; Analgesics, Opioid/adverse effects ; Anesthesia/adverse effects* ; Anesthesia/methods ; Anesthetics, Inhalation/adverse effects ; Breast Neoplasms/immunology* ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Female ; Fentanyl/adverse effects ; Humans ; Immunity, Cellular/drug effects* ; Immunocompromised Host/drug effects ; Immunocompromised Host/immunology ; Killer Cells, Natural/drug effects* ; Killer Cells, Natural/immunology ; Methyl Ethers/adverse effects ; Middle Aged ; Pain Management/adverse effects* ; Pain Management/methods ; Pain Measurement ; Perioperative Care/adverse effects ; Piperidines/adverse effects ; Propofol/adverse effects ; Prospective Studies
Keywords
analgesia ; anesthesia ; breast cancer ; immunity ; natural killer cell
Abstract
Introduction: Perioperative anesthesia and analgesia exacerbate immunosuppression in immunocompromised cancer patients. The natural killer (NK) cell is a critical part of anti-tumor immunity. We compared the effects of two different anesthesia and analgesia methods on the NK cell cytotoxicity (NKCC) in patients undergoing breast cancer surgery. Methods: Fifty patients undergoing breast cancer resection were randomly assigned to receive propofol-remifentanil anesthesia with postoperative ketorolac analgesia (Propofol-ketorolac groups) or sevoflurane-remifentanil anesthesia with postoperative fentanyl analgesia (Sevoflurane-fentanyl group). The primary outcome was NKCC, which was measured before and 24 h after surgery. Post-surgical pain scores and inflammatory responses measured by white blood cell, neutrophil, and lymphocyte counts were assessed. Cancer recurrence or metastasis was evaluated with ultrasound and whole body bone scan every 6 months for 2 years after surgery. Results: The baseline NKCC (%) was comparable between the two groups (P = 0.082). Compared with the baseline value, NKCC (%) increased in the Propofol-ketorolac group [15.2 (3.2) to 20.1 (3.5), P = 0.048], whereas it decreased in the Sevoflurane-fentanyl group [19.5 (2.8) to 16.4 (1.9), P = 0.032]. The change of NKCC over time was significantly different between the groups (P = 0.048). Pain scores during 48 h after surgery and post-surgical inflammatory responses were comparable between the groups. One patient in the Sevoflurane-fentanyl group had recurrence in the contralateral breast and no metastasis was found in either group. Conclusions: Propofol anesthesia with postoperative ketorolac analgesia demonstrated a favorable impact on immune function by preserving NKCC compared with sevoflurane anesthesia and postoperative fentanyl analgesia in patients undergoing breast cancer surgery.
Files in This Item:
T201702742.pdf Download
DOI
10.7150/ijms.20064
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Koo, Bon-Nyeo(구본녀) ORCID logo https://orcid.org/0000-0002-3189-1673
Kim, Seung Il(김승일)
Park, Se Ho(박세호) ORCID logo https://orcid.org/0000-0001-8089-2755
Park, Hyung Seok(박형석) ORCID logo https://orcid.org/0000-0001-5322-6036
Cho, Jin Sun(조진선) ORCID logo https://orcid.org/0000-0002-5408-4188
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160611
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