[PP.03.07] INFLUENCE OF ANAESTHESIA ON THE CYTOKINE'S LEVEL IN ELDERLY WITH CONCOMITANT CARDIOVASCULAR DESEASES

Abstract

Increase in the number of elderly patients is a serious problem for anesthesiology. The incidence of systemic inflammation in elderly is 20 to 30%, depending on the severity of the patient and other factors [Nearman H. et al., 2014]. In 40% of patients with SIRS promotes postoperative multiple organ dysfunction. This increases the number of postoperative complications and mortality increases to 50% [Menyar A. et al., 2012]. The goal of our study was to examine and evaluate markers of Inflammatory Response in elderly after general anaesthesia.

We examined 105 patients aged 60 to 82 years for abdominal surgery with total intravenous anesthesia. There were representative of the gender, age, ASA, BMI, Euroscore. Preoperative patients with CVD managed in accordance with ESC Guidelines (2014). IL-1, TNF, IL-6, IL-10 in EDTA-plasma determined by enzyme immunoassay (set Biomedica). Data are presented as M ± m, statistically significant value of p < 0,05.

The severity of the patients corresponded to 48% of ASA II, 52% - ASA III. We compared the levels of IL-1, TNF, IL-6, IL-10 in elderly preoperatively, after anesthesia and to 5 days postanesthesia. Preoperatively the level of proinflammatory IL 6 exceeded the norm by 64,2%, TNF - on 61,5%. The level of anti-inflammatory IL 10 exceeded the norm by 58,4% (p = 0,000001), The inflammatory activity index (IL 6/IL 10) was normal. After anaesthesia the level of IL 1 increased by 35.9% (p = 0.04). The level of IL6 increased output value to 2651% (p = 0.002). The concentration of IL 10 not statistically different from the norm and output levels. IL 6 level higher than the initial value by 2971% (p = 0,002). Not found significant changes in the level of TNF. The index IL 6/IL 10 was 4125% (p = 0,000018) above normal.

Elderly patients preoperative showed a non-specific activation of the inflammatory response that manifested as high in pro-inflammatory and anti-inflammatory cytokines. After anesthesia in elderly we detected the inflammatory activation, which was confirmed by the increasing levels of cytokines and value index IL 6/IL 10.