Shu Matsukawa

Interleukin-10 Production During and After Upper Abdominal Surgery

STUDY OBJECTIVE To evaluate the influence of major abdominal surgery on the plasma levels of interleukin-10 (IL-10). DESIGN Prospective study. SETTING University hospital. PATIENTS 10 ASA physical status I and II patients undergoing upper abdominal surgery. INTERVENTIONS All patients received combined general-epidural anesthesia with isoflurane and nitrous oxide, after insertion of an epidural catheter at T8-T9 dosed with 1.5% lidocaine. MEASUREMENTS AND MAIN RESULTS Plasma interleukin-6 (IL-6), interleukin-8 (IL-8), and IL-10 levels were determined with an enzyme-linked immunosorbent assay at preanesthesia, 0, 2, and 4 hours during surgery, and at the end of surgery, followed by sampling on the morning of postoperative days 1 (POD1) and 3 (POD3). Before anesthesia and at 0 hours of surgery, IL-10 was not detected. In all ten patients, the plasma levels of IL-10 showed significant elevations and achieved their maximal value 4 hours after the skin incision (p < 0.05 vs. baseline). The plasma IL-10 levels returned to preanesthesia levels on POD3. The plasma levels of IL-6 and IL-8 also increased in the perioperative period. The peak cytokine levels correlated (r = 0. 915, p = 0.0001 for IL-6 vs. IL-8; r = 0.82, p = 0.025 for IL-6 vs. IL-10; and r = 0.641, p = 0.06 for IL-8 vs. IL-10). The peak plasma IL-10 levels significantly correlated with the amount of intraoperative blood loss (r = 0.69, p < 0.05). CONCLUSIONS In patients undergoing major abdominal surgery, plasma IL-10 levels were elevated during and after operation. IL-10 may modulate the inflammatory responses in the perioperative period.

Comparison between in vivo and in vitro pharmacokinetics of succinylcholine in humans.

AbstractPurpose. To compare the in vivo and in vitro pharma-cokinetics of succinylcholine (SCh) in humans. Methods. A bolus of SCh 1 mg·kg−1 (n = 7) or 2 mg·kg−1 (n = 11) was given to 18 patients anesthetized with thiopental. Arterial blood samples for determination of in vivo SCh concentrations were collected every 30 s for 5 min. Another 20-ml blood sample was obtained before induction of anes-thesia for determination of in vitro SCh. Concentrations of SCh were measured by high-performance liquid chromato-graphy. In vivo and in vitro concentrations of SCh vs time data were analyzed by the one-compartment model. Results. The respective in vivo and in vitro pharmacokinetic parameters (SCh 1 mg·kg−1vs SCh 2 mg·kg−1) were as follows: Plasma clearance was 4.17 ± 2.37 and 1.85 ± 0.28 l·min−1, P < 0.05, vs 2.91 ± 2.01 and 1.27 ± 0.43 l·min−1, P < 0.05. Elimination half-life was 25.4 ± 10.6 and 47.4 ± 5.4 s, P < 0.002 vs 26.3 ± 10.0 and 75.2 ± 21.8 s, P < 0.00005. Conclusion. These results suggest that the rapid disap-pearance of SCh from the circulation is due to diffusion out of the blood vessels rather than to enzymatic hydrolysis.