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Anesth Analg 2009; 108:916-920
© 2009 International Anesthesia Research Society
doi: 10.1213/ane.0b013e318193fd89
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CRITICAL CARE AND TRAUMA

Alcohol Use Disorder and Perioperative Immune Dysfunction

Alexandra Lau, MD, Vera von Dossow, MD, Michael Sander, MD, Martin MacGuill, MD, Nadine Lanzke, DVM, and Claudia Spies, MD

From the Department of Anesthesiology and Intensive Care Medicine Unit, Campus Virchow-Klinikum and Campus Charité Mitte, Charité-University Hospital Berlin, Berlin, Germany.

Address correspondence and reprint requests to Claudia Spies, MD, Department of Anesthesiology and Intensive Care Medicine, Charité Campus Mitte, Charitéplatz 1, 10098 Berlin, Germany. Address e-mail to claudia.spies{at}charite.de.

The anesthesiological sequelae of long-term alcohol abuse include a three to fivefold increased risk of postoperative infection, prolonged intensive care unit stays and longer hospital stays. The cause of the higher infection rates is an altered immune response in long-term alcoholic patients. Preoperatively, the T helper cells 1 to T helper cells 2 ratio is depressed in long-term alcoholic patients and remains suppressed after surgery. The lower preoperative T helper cells 1 to T helper cells 2 ratio is predictive of later onset of infections. Postoperatively, the cytotoxic lymphocyte (Tc1/Tc2) ratio is decreased in long-term alcoholic patients and remains depressed for 5 days. The interleukin (IL)-6/IL-10 ratio and the lipopolysaccharide-stimulated interferon {gamma}/IL-10 ratio in whole blood cells are decreased after surgery in long-term alcoholic patients. Depressed Tc1/Tc2, IL-6/IL-10 and lipopolysaccharide-stimulated interferon {gamma}/IL-10 ratios in the postoperative period are predictive of subsequent postoperative infections. Perioperative interventions should aim to minimize dysregulation of the immune system.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2009 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2009 by the International Anesthesia Research Society.