Search

Polymorphonuclear leukocytes (PMNL) make an outstanding contribution to the defence against invading bacteria. We studied the effects of midazolam, droperidol, fentanyl, and alfentanil on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro. Using a method described by Eggleton et al., PMNL were isolated from venous blood samples obtained from ten volunteers. The fluorescence microscopic method mentioned by Bellinati-Pires et al. was used to examine phagocytosis and killing. Whereas both midazolam and droperidol caused a significant inhibition of phagocytosis as well as bactericidal activity, fentanyl and alfentanil did not influence these PMNL functions. In order to find out whether midazolam and droperidol are able to intensify perioperative bacterial infections in vivo as well, additional clinical studies should be conducted.

Polymorphonuclear leukocytes (PMNL) are important components of the immunological defence system which protects the human organism from invading bacteria. Using a fluorescence microscopic method, we examined the influence of propofol and its solvent intralipid on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro. Propofol inhibited (Por = 0.001) phagocytosis of Staphylococcus aureus as well as Escherichia coli. Killing of Staphylococcus aureus (Por = 0.001) and of Escherichia coli (Por = 0.01) was suppressed. Intralipid, by itself, impaired phagocytosis of Escherichia coli (Por = 0.05). Apart from that, intralipid produced no relevant effects. Additional clinical studies regarding the influence of propofol on PMNL function are recommended.

Polymorphonuclear leukocytes (PMNL) play an important part in protecting against invading bacteria. It is known that some anaesthetics may impair PMNL functions, thus possibly promoting infection. We investigated the effect of fentanyl and alfentanil on superoxide anion production, hydrogen peroxide generation, and activity of released myeloperoxidase in vitro. However, the two opioids did not have any significant influence on the tested PMNL functions.

Monocytes play an important role in humoral as well as in cell-mediated immunity. In the present study, the influences of the anti-migraine preparations metoprolol, propranolol, metoclopramide, acetylsalicylic acid, dihydro-ergotamine and sumatriptan on monocyte chemotaxis were examined in vitro. First, mononuclear cells were isolated by centrifugation from venous blood samples obtained from 10 healthy male volunteers. Chemotaxis was determined using a microchemotaxis chamber. While metoprolol, metoclopramide, dihydroergotamine and sumatriptan did not influence monocyte chemotaxis, high doses of propranolol and acetylsalicylic acid caused a significant (por = 0.001) inhibition of this important cellular function. Therefore, it is quite possible that both drugs produce adverse immunological effects in vivo in cases of high dosage or obstruction of elimination.

Polymorphonuclear leucocytes (PMNL) are an essential contribution to protection from bacterial infection. We have examined the effects of thiopentone, etomidate, ketamine and flunitrazepam on phagocytosis and killing of Staphylococcus aureus and Escherichia coli by PMNL in vitro with fluorescence microscopy. All anaesthetic agents significantly inhibited both phagocytosis and bactericidal activity. The additives in the commercial preparations may have contributed to the suppression.

Polymorphonuclear leucocytes (PMNL) are an essential component of the defence system against invading bacteria. There is evidence that some anaesthetics are able to suppress PMNL functions, promoting, perhaps, perioperative infection. We studied the effects of thiopentone, etomidate, ketamine, and midazolam on the generation of bactericidal agents (superoxide anion, hydrogen peroxide, and myeloperoxidase) by PMNL in vitro. Thiopentone inhibited superoxide anion (Por = 0.01) as well as hydrogen peroxide production (Por = 0.001). However, there was no statistically significant effect on myeloperoxidase release. Neither etomidate nor ketamine influenced the PMNL functions tested to any extent. Midazolam suppressed superoxide anion generation (Por = 0.01) but only if a concentration far beyond clinical relevance was used.

Polymorphonuclear leukocytes (PMNL) play a vital role in the defence against invading bacteria. It is known that some anaesthetics inhibit PMNL function and, thus, possibly enhance perioperative infection. We investigated the effect of methohexitone, flunitrazepam, and droperidol on three bactericidal PMNL functions, i.e., superoxide anion production, hydrogen peroxide generation, and activity of released myeloperoxidase, in vitro. Approved photometrical assays were used. Superoxide anion was measured by the reduction of cytochrome C, hydrogen peroxide by the horse radish peroxidase catalysed oxidation of phenol red, and myeloperoxidase by the turnover of 2,2'-azino-di(3-ethylbenzthiazoline) sulfonic acid. Methohexitone (P < or = 0.001) and flunitrazepam (P < or = 0.01) inhibited superoxide anion production, and methohexitone (P < or = 0.01) reduced hydrogen peroxide generation but only at concentrations beyond clinical relevance. Droperidol did not cause any alteration of the PMNL functions tested. Consequently, it seems unlikely that the usual doses of methohexitone, flunitrazepam, or droperidol promote bacterial infections in vivo by impairing the activity of myeloperoxidase or by inhibiting the generation of superoxide anion or hydrogen peroxide.

Infection remains a major cause of morbidity and mortality in intensive care medicine. The increased susceptibility of the severely injured patient to sepsis and consecutive multiorgan failure has been attributed to abnormalities in cell-mediated immunity. The purpose of our study was to determine changes in the pattern of lymphocyte subpopulations in severely injured patients and to relate these changes to any development of sepsis and to outcome (indirect immunofluorescence with monoclonal antibodies). During 14 months we investigated 28 patients (ages 15-65 years) suffering from severe multisystem trauma (22 cases) or diffuse peritonitis (6 cases), 6 of whom (21.4%) developed sepsis and multiorgan failure; 4 of these 6 septic patients died. According to the clinical data, patients developed sepsis between the 3rd and 6th days after trauma. We therefore defined days 1-3 as the preseptic phase, days 3-6 as the phase of sepsis development, and days 4-10 as the phase of septic disease. In the preseptic phase there was no statistically significant difference in the pattern of the eight lymphocyte subpopulations measured between patients who later developed sepsis and those who did not. During the phase of sepsis development, however, the patients who did develop sepsis showed significantly reduced numbers of CD2-, CD8-, and CD20-positive cells (P = 0.0003; P = 0.009; P = 0.012). The number of helper cells (CD4) was also decreased, but the difference between the two groups failed to reach statistical significance (P = 0.08).(ABSTRACT TRUNCATED AT 250 WORDS)

Somatosensory evoked potentials (SEP) after median nerve stimulation were recorded in 40 patients during infusion of either 15 mg/kg bw thiopentone or 1 mg/kg bw etomidate (n = 10) within 15 min and after 0.3 mg/kg bw etomidate (n = 20). Marked alterations of SEP waveforms and changes in latencies were observed in all patients. Central conduction time (CCT) was significantly correlated to plasma thiopentone concentration. Infusion of high doses of thiopentone and etomidate was followed by a complete loss of middle and long latency components. Amplitude of the primary cortical SEP N20 was found to be unchanged after thiopentone and to be increased after etomidate, indicating the synchronizing properties of this drug. A pronounced increase in SEP latencies and CCT and waveform alterations have to be considered during hypnotic drug administration in intensive care medicine and intraoperatively.

The influence of clinically relevant concentrations of thiopentone sodium, methohexitone, and etomidate on polymorphonuclear neutrophilic granulocyte (PMN) adherence was investigated in vitro by using nylon fibre columns. The three induction agents produced dose-dependently a significant (p less than 0.01) reduction in adherence. This effect is possibly related to increased risk of postoperative bacterial infection. Further studies on this problem are recommended.

44 patients undergoing comparable gynaecological operations received either halothane- modified neuroleptanaesthesia or a combination of epidural and NLA. Monoclonal antibodies were used to determine 8 different lymphocyte subpopulations in blood samples drawn before and after anaesthesia and on the first postoperative day. Cell populations were counted by fluorescent microscopy. Halothane anaesthesia produced both a depression of T-cells (72.67% preoperatively to 52.79% postoperatively) and of the helper/suppressor ratio (1.46 to 1.10); meanwhile activated T-cells increased from 2.33% to 6.83%. After neuroleptanaesthesia as well as after halothane the HLA-DR positive cells decreased (21.05% to 19.29%; 25.22% to 20.29%). The B-cell fraction was elevated from 2.33% to 6.83% following combined anaesthesia. The potential of the anaesthetics to produce subsequent alterations in host defense is discussed.

The influence of clinically relevant concentrations of fentanyl, alfentanil, morphine, pethidine, and buprenorphine on polymorphonuclear neutrophilic granulocyte (PMN) adherence was investigated in vitro by using nylon fibre columns. Since none of the drugs produced any significant (p less than 0.05) change of adherence, no evidence of opioid mediated increased risk of postoperative bacterial infection could be found.

Alfentanil mask anaesthesia was performed in 63 patients undergoing termination of pregnancy or curettage. Three different types of premedication were used: a) pethidine, promethazine, and atropine; b) diazepam and atropine; c) atropine. The patients were ventilated either with nitrous oxide and oxygen or with halothane and oxygen. Halothane reduced the frequency of muscular rigidity (32%; N2O 75%), postoperative sickness, and vomiting (23%; N2O 50%). On the other hand, patients regained consciousness earlier if nitrous oxide was used. Premedication a) also reduced the frequency of nausea and emesis (21%; other premedications 63%).-Alfentanil intubation anaesthesia was performed in 52 patients undergoing laparoscopy. Premedication and inhalation anaesthetic varied as described above in the group with mask anaesthesia. Muscular rigidity did not occur, and nausea/emesis were rare events (8%). Halothane prolonged the recovery phase of consciousness and respiration. Premedication a) also resulted in respiratory depression.

A demand-controlled alfentanil bolus technique, which proved to be a safe and easy-to-handle method in 22 neurosurgical operations of mean and longer duration, is described. In the case of these not very painful procedures the use of more complicated time-controlled bolus or infusion techniques does not seem to be necessary.

The influence of midazolam and ketamine on polymorphonuclear neutrophil granulocyte (PMN) adherence was investigated in vitro by using nylon fiber columns. Both a concentration of 1.0 microgram midazolam/ml blood and 0.2 microgram/ml caused a reduction of adherence. This decrease was significant (p less than 0.05) in the case of the higher dosage. The two concentrations of ketamine used (1.3 micrograms/ml resp. 0.5 microgram/ml) produced a significant reduction of adherence too. Thus both anesthetic agents are able to impair PMN function in vitro dose-dependently. This feature is possibly related to increased risk of postoperative bacterial infection. Further studies concerning this problem should be conducted.