الفهرس 
THE IMMUNE SYSTEMOnly 14 pages are availabe for public view
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Abstract
The immune system alteration with the stress of anaesthesia and surgery ts getting increasing
attention nowadays. The regulatory role of the immune system to many non immune function has
led to more interest to decrease the postoperative immunodeficiency as a consequence of stress. The
imerleukin 1 level. one of the very sensitive immunological mediator in stress response was found
to have good cmTelation with the postoperative surgical morbidity and mortality.
The present study was undertaken to evaluate and compare the efficiency of halothane versus low
dose fentanyl and epidural anaesthesia on the hemodynamic data, MIF and serum interleukin
1 level as a reliable indicator to stress response in orthopedic patients with fracture femur.
Patients were randomly divided into 3 groups (30 patients each). In the halothane and fentanyl
groups, anaesthesia was induced with sodium thiopental (4 mg/kg) and suxamethonium (1 mglk:g)and
controlled ventilation was carried out using pancromium (0.04 mg/kg) and reversed at the end of
operation by mixture of neostigmine and atropine (2.5 mg and l mg). In the halothane group
maintenance was done with 40% oxygen, 60% nitrous oxide and halothane 1.5o/c
:-<.i
while 1n tlK’ fentanyl group m;untL’narKL was done With -W(·C \),\.y_g-en. 6(Y-;
mtrous oxide and incremental Intravenous do:-;es of fentanyl (maximum 5 microgram/kg). In
the halothane and fentanyl groups. postoperative analgesia was achieved with intramuscular
morphine. [n the epidural group, 10-12 ml of bupivacine (0.59C solution) \vas used to achieve
anaesthetic level up toT 10. Postoperative analgesia was achieved with topping doses
through epidural catheter in the next 2 days. Blood pressure, heart rate and
cenu·al venous pressure was monitored throughout the procedure. Blood samples were drawn
10 minute before induction. 30 minutes after skin incision and 2 days
postoperative.
Results of this work has revealed that changes in hemodynamic parameters (blood
pressure, H.R. and CVP) were clinically insignificant in the three groups either when
comparison was done between groups or done between changes in each parameter at different
times in the same group during the whole surgical procedure.
Results also demonstrated that epidural anaesthesia could attenuate the stress response to
surgery as proved by the preservation of the notmal course of IL-l level and the
preservation of the migratory components of leucocytes. While in the halothane group and in
the low dose fentanyl group there were suppression of the nonnal increase in the IL-l
level and suppression of MIF.