الفهرس 
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Abstract
Surgery stimulates production of a variety of endogenous
mediators, and these mediators initiate activation of hypothalamopituitary-
adrenal (HPA) axis and resultant stimulation of glucocorticoid
secretion seem to be of extreme importance (Joris et al., 1992).
Cytokines are important mediators of the physiological response to
surgical trauma. Interleukin-6 is the major cytokine found after surgery.
Interleuken-6 is produced from T cells, B cells, macrophages and other
immunocomponent cells. It plays an important role not only in the
immune reaction, but also in acute phase reaction and the defence
mechanism (Horii et al., 1988).
Over the past decade, there has been intense interest in obtunding
the endocrine and metabolic response to surgery with the expetation that
this will decrease postoperative morbidity. Even when abolition of this
response has been achieved, little benefit in postoperative morbidity has
been shown , in spite of occasional claims to the contrary. It has been
suggested that the failure to improve postoperative recovery is caused byinability
to alter the IL-6 response and hence cytokine-mediated changes
(Brouwer et al., 1995).
The study was conducted in 30 healthy ASA physical status I or II
patients, aged 20-50 years, presenting for pelvic surgery. Patients were
randomly assigned into three equal study groups. The three groups
differed solely in the narcotic which they received before induction of
anesthesia, (fentanyl in group I, sufentanil in group II & morphine in
group III respectively).
Preanaesthetic medication consisted of oral diazepam 90 min
before induction of anesthesia, while monitoring included
electrocardiograph and non-invasive arterial pressure.
In three groups of patients, anaesthesia was induced with a dose of
thiopentone sufficient to obtund the eyelash reflex. Suxamethonium, 1
mg / kg, was administered immediately after loss of consciousness.
The lungs were manually ventilated with 100% oxygen prior to tracheal
intubation.
,.,., .
107
Effect OfOpioids On The
IL-6 Response To Surgery
Summary & Conclusion
Tracheal intubation was performed one minute after completion of
the suxamethonium dose. After proper endotracheal tube placement was
confirmed, pancuronium, 0.1 mg / kg, was administered immediately
after regaining of spontaneous respiration to maintain anesthesia together
with using 0.5-1% halothane in oxygen.
Venous blood samples were collected at three time periods (before
induction of anesthesia, immediately post-intubation, and 30 min after
skin incision). The haemodynamic variables (heart rate and mean arterial
pressure) were measured at such study times as well. IL-6 was measured
with commercially available ELISA systems.
It was observed that morphine analgesia may eliminate the increase
in IL-6 concentrations in response to pelvic surgery in adults, while the
effects of either fentanyl or sufentanil analgesia are less clear.
The present study offers the evidence that variations in anaesthetic
management influence the IL-6 response to surgery. This observation
raises the immediate question of whether or not modifications of IL-6
secretion are of clinical relevance.
In this respect, Ertel and colleagues (1990) found a correlation
between large concentrations of IL-6 in trauma patients and increased
incidence of infectious complications, which could be interpreted as
evidence that it might be beneficial to attenuate the IL-6 response.
Similar data have been presented by Oka and co-workers (1992), who
found that IL-6 was a useful predictor of postoperative complications.
Libert and colleagues (1992) also demonstrated moderate efficacy of
monoclonal antibodies against IL-6 or IL-6 receptor in reducing the
mortality of septic shock . There is also the finding of Finkel and
colleagues (1993) who proposed that IL-6 impairs cardiac function.
Interleukin-6 has a multifactorial role in the body’s response to
tissue injury and its lack !! may also contribute to the immunosuppression
associated with surgery (Crozier et at, 1994). .
It was concluded from this study that pre-induction dose of
morphine suppressed the operative increase in IL-6 more effectively than
either fentanyl or sufentanil given in equipotent analgesic doses.