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Painful regional anaesthesia induces an immunological stress reaction: the model of retrobulbar anaesthesia

Published online by Cambridge University Press:  16 August 2006

G. Heine
Affiliation:
Department of Nephrology, University of Saarland, Homburg, Germany
H. Gabriel
Affiliation:
Institute of Sports Medicine, Friedrich-Schiller-University Jena, Jena, Germany
J. Weindler
Affiliation:
Department of Ophthalmology, University of Saarland, Homburg Germany
K. W. Ruprecht
Affiliation:
Department of Ophthalmology, University of Saarland, Homburg Germany
W. Kindermann
Affiliation:
Institute of Sports and Performance Medicine, University of Saarland, Saarbrücken, Germany
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Abstract

Background and objective Laboratory stress studies found that acute psychological stresses may elicit changes in leukocyte numbers similar to those occurring in physical stresses. Both types of stress evoke – mainly by release of catecholamines – leukocytosis resulting from a release of natural killer cells (NK-cells), of CD8+ T-cells, of monocytes and of neutrophils. However, there is little proof that laboratory stress models can be applied to daily clinical routines. As a likely inductor of an immunological stress response the setting of retrobulbar anaesthesia prior to intraocular surgery permits the study of a short-term painful anaesthetic procedure under highly standardized conditions. This was examined in 16 female patients.

Methods Counts of leukocyte subsets, serum cortisol and cardiovascular variables were measured 30 min and 1 min prior to retrobulbar anaesthesia as well as 2, 15 and 45 min afterwards.

Results The setting of retrobulbar anaesthesia induced an increase in total leukocytes [+380 cells μL−1; P < 0.01 (means; significance level)] mainly due to rising counts of neutrophils (+241 cells μL−1, P < 0.01). Of all lymphocyte subpopulations, natural killer cells increased most markedly (+64 cells μL−1; P < 0.01). Furthermore, the retrobulbar block induced an increase in systolic arterial pressure (+15.2 mmHg; P < 0.01).

Conclusion These changes in immunological and cardiovascular variables are considered to be elements of a sympatho-adrenal stress reaction; catecholamines are considered to induce a demargination of leukocytes by binding to β2-adrenoceptors and by modifying the avidity state of adhesion molecules.

Type
Original Article
Copyright
2001 European Society of Anaesthesiology

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