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REGIONAL ANESTHESIA

The In Vivo Effects of General and Epidural Anesthesia on Human Immune Function

Marcia A. Procopio, MD^*, Athos J. Rassias, MD^*, Joyce A. DeLeo, PhD^*, Janice Pahl, BA^*, Laurie Hildebrandt, BS^*, and Mark P. Yeager, MD^*

Departments of *Anesthesiology and Pharmacology, Dartmouth Medical School, Hanover, New Hampshire and Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Address correspondence and reprint requests to Marcia A. Procopio, MD, Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756. Address e-mail to Marcia.A.Procopio{at}Hitchcock.org

Impaired in vivo immunity is often observed after major surgery and is multifactorial. We conducted a randomized clinical study to determine the independent effects of general anesthesia (GA) and of lumbar epidural anesthesia (LEA) on human immune function in the absence of surgical trauma. Nineteen healthy volunteers were randomized to receive GA with thiopental and isoflurane, LEA with lidocaine, or no anesthesia (Control). Serial blood samples were tested for antibody responses to antigen inoculation, neutrophil and mononuclear cell antibody-dependent cell cytotoxicity (ADCC), natural killer cell cytotoxicity, and neutrophil phagocytic activity. Antibody responses were similar in the three groups. Mononuclear cell ADCC increased in the LEA group at the end of the anesthetic (P < 0.05 at effector/target [E/T] ratios of 10:1, 25:1, and 50:1). Natural killer cell cytotoxicity increased at the end of the anesthetic in both the LEA group (P < 0.05 at all E/T ratios) and the GA group (P < 0.05 at an E/T ratio of 5:1 and 10:1). No significant changes were observed for neutrophil ADCC or phagocytosis. General or epidural anesthesia alone, in the absence of surgery, seems to have only transient and minor effects on human immune function.

IMPLICATIONS: General or epidural anesthesia alone, in the absence of surgery, seems to have only transient and minor effects on human immune function.

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