Utjecaj primjene različitih tehnika anestezijena imunosni odgovor organizma: pregled literature
2020
The immune system comprises both specific and non-specific immunity. The immune response during
the perioperative period is modulated by tissue trauma, fear/anxiety, medication, hypothermia, pain, transfusion
of blood products, glycaemia regulation, infection and increased stress. Anaesthesia can influence the stress
response by central modulation (general anaesthesia), afferent blockade (regional anaesthesia), or by interaction
with the endocrine system. The choice of anaesthetic technique seems to have an influence on cancer cells and
their possible dissemination. The aims of this review article are to review the effects of regional anaesthesia in
comparison to general anaesthesia (intravenous and inhalational) on the immune response to surgical stress,
malignant disease progression and postoperative organ function. It is known that general anaesthesia can suppress
cellular and humoral immunity by acting on immune-competent cells, gene expression and secretion of
inflammatory mediators. Opioids and/or their mode of administration show a different effect on the immune
system: immune suppression, immune stimulation or both. In contrast, local anaesthetics are efficient in treating
acute and chronic inflammation because they deactivate inflammatory processes on different levels, including the
monocyte-macrophage system, decrease of oxygen metabolites and free radical formation, histamine liberation,
release of interleukin (IL-1α) and leukotriens. To minimise or avoid immune reactions, the use of local and regional
anaesthesia is recommended, as it is superior to other analgesic methods and also reduces postoperative blood
loss. Because of these significant advantages, today the use of regional anaesthesia is widespread in oncological
surgery.
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