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Comparison of the effects of xenon and sevoflurane anaesthesia on leucocyte function in surgical patients: a randomized trial†   A.V. Fahlenkamp, M. Coburn,

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Presentation on theme: "Comparison of the effects of xenon and sevoflurane anaesthesia on leucocyte function in surgical patients: a randomized trial†   A.V. Fahlenkamp, M. Coburn,"— Presentation transcript:

1 Comparison of the effects of xenon and sevoflurane anaesthesia on leucocyte function in surgical patients: a randomized trial†   A.V. Fahlenkamp, M. Coburn, R. Rossaint, C. Stoppe, H. Haase  British Journal of Anaesthesia  Volume 112, Issue 2, Pages (February 2014) DOI: /bja/aet330 Copyright © 2014 The Author(s) Terms and Conditions

2 Fig 1 Study procedure and flow chart. A sketch of the study procedure is presented (a). After screening and informed consent, subjects were randomly assigned to one of the study groups receiving either xenon or sevoflurane for maintenance of general anaesthesia during surgery. Blood sample I was obtained directly before the induction of anaesthesia, that is, before the application of anaesthetics. Blood sample II was obtained 1 h after wash-in of either xenon or sevoflurane. A detailed flow chart pictures the subjects enrolled in the trial including the reasons for study drop-out (b). Sixty subjects in total were assessed for eligibility and randomized after written informed consent into one of the equally sized study groups. Pre-interventional drop out in the xenon group occurred in six cases (¶): two subjects withdrew their consent; one was excluded after randomization for safety reasons. Two subjects did not receive the scheduled surgery; one subject did not receive the allocated intervention for administrative reasons. Correct blood sampling was not performed in one case ($). Exclusion during data analysis was performed for one subject who had received a steroid before sampling Pre-interventional drop-out in the sevoflurane group occurred in four cases (¥): one subject was excluded after randomization for safety reasons, one subject did not receive the scheduled surgery; one subject did not receive the allocated intervention for administrative reasons, and in one case, a violation of the study protocol occurred. Correct blood sampling was not performed in one case (&). Exclusion during data analysis was performed in five cases in which a steroid was received before sampling (§). In total, samples of 22 subjects in the xenon group and 20 subjects in the sevoflurane group were included. British Journal of Anaesthesia  , DOI: ( /bja/aet330) Copyright © 2014 The Author(s) Terms and Conditions

3 Fig 2 Leucocytes and leucocyte subpopulations. The numbers of leucocytes in the subject’s blood samples are shown (a). In the sevoflurane sample II, there were significantly fewer leucocytes than in sevoflurane sample I. No further significant differences were found between the groups. Results are given as mean (standard deviation). (*P<0.05.) Leucocytes in the samples divided into subgroups are depicted (b–d). While there are significant differences in lymphocyte numbers (b) between xenon and sevoflurane samples, no further significance was found in monocyte (c) or granulocyte (d) numbers comparing xenon and sevoflurane subjects. In sevoflurane sample II, there were significantly fewer lymphocytes and granulocytes than in sevoflurane sample I. Results are given as mean (standard deviation). (*P<0.05.) British Journal of Anaesthesia  , DOI: ( /bja/aet330) Copyright © 2014 The Author(s) Terms and Conditions

4 Fig 3 Cytokine release and phagocytosis/oxidative burst capacity. After 4 h of incubation with 25 ng ml−1 and 1 µg ml−1 LPS, cytokine release from leucocyte preparations was assessed by ELISA (a–c). Samples treated identically except for LPS addition served as controls (0 ng ml−1 LPS). TNF-α (a), IL-1β (b), and IL-6 (c) release was significantly elevated after LPS stimulation compared with controls in all experimental settings. Significantly higher concentrations of TNF-α were found in all groups after stimulation with 1 µg ml−1 compared with 25 ng ml−1 LPS (a). IL-1β concentrations were significantly elevated after stimulation with 1 µg ml−1 compared with 25 ng ml−1 LPS only at baseline sampling in the xenon group (b). Significant differences in IL-6 release when comparing 25 ng ml−1 and 1 µg ml−1 LPS were found after 1 h of anaesthesia in the xenon group and at baseline in the sevoflurane group (c). No statistically significant differences were detected between xenon and sevoflurane treatment, or between different sample times. Results are given as mean (standard deviation). (*P<0.05; ** P<0.01; *** P<0.001.) Phagocytotic and oxidative burst capacity before and after 1 h of xenon or sevoflurane anaesthesia is given in (d–f) for granulocytes and in (g–i) for monocytes. The total number of active granulocytes was slightly but significantly reduced in the xenon group but not after sevoflurane (d). Active monocyte numbers did not differ between the groups or between the two sampling times (g). In granulocytes, phagocytotic (e) and oxidative burst capacity (f) were significantly reduced in both groups after 1 h of anaesthesia. In monocytes, neither phagocytotic (h) nor oxidative burst capacity (i) was affected by anaesthesia. With both cell types, no significant differences were found regarding the anaesthetic regimen. Results are given as mean (standard deviation). (*P<0.05; ** P<0.01.) British Journal of Anaesthesia  , DOI: ( /bja/aet330) Copyright © 2014 The Author(s) Terms and Conditions

5 Fig 4 MAPK activation. A representative western blot showing phosphorylated mitogen MAPK p38 and ERK 1/2 in leucocytes from blood samples before and after induction of anaesthesia is depicted (a). The cytoskeleton protein β-actin served as a loading control. Western blots were performed from the samples of seven subjects per group. The results of the densitometric evaluation of phospho-p38 (pp38) and phospho-ERK1/2 (pERK) to β-actin are displayed as mean (standard deviation) (b and c). No significant differences were found regarding p38 phosphorylation after both anaesthetic regimens (b). Phosphorylated ERK was reduced after 1 h of anaesthesia in the xenon group (c, * P<0.05). British Journal of Anaesthesia  , DOI: ( /bja/aet330) Copyright © 2014 The Author(s) Terms and Conditions


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