Study of the immune state in different variants of anesthetic support for total laryngectomy

Анотація

Peculiarities of operative interventions for malignant neoplasms of the larynx, their traumatic nature, and side effects of opioid use require the search for optimization of anesthesia and perioperative analgesia aimed at reducing surgically and anesthetically induced immunosuppression and related negative consequences.Aim: to investigate the immune status of laryngeal cancer patients with different options of anesthetic support for total laryngectomy and to evaluate the relationship between perioperative im­munosuppression and the use of various adjuvant components of analgesia (dexmedetomidine and lidocaine).100 patients with T3-4N0-3M0 laryngeal cancer who underwent total laryngectomy were included in the study. Patients were evenly and comparably divided into 4 research groups (n=25) based on the main clinical and age-sex characteristics (p>0.05) depending on the use of adjuvant components of multimodal anesthesia: in the group 1 they were not used, only opioid analgesics, in group II – lidocaine was used, in group III – dexmedetomidine, and in group IV – both lidocaine and dexmedetomidine. Studies of markers of the immune state (leucoformula, IL-2 and TNF-α) were carried out on the 1st, 2nd, 5th and 7th days after surgery. Statistical analysis was carried out using STATISTICA v.6.1 (Statsoft Inc., USA, license number AGAR909E415822FA), it included parametric and non-parametric, and analytical statistics, parametric and non-parametric variance analysis descriptive of ANOVA, repeated measurements with an assessment of the degree of influence of an independent factor on the studied characteristic. A relatively stable state of cellular immunity and a certain suppression of humoral immunity after total laryngectomy was determined. Immunosuppression was most evident on the 2nd day after surgery in the  group 1 with standard opioid anesthesia. The best indicators of the immune state were determined in group IV of the study. The method of anesthesia had the greatest influence on the state of immunosuppression (according to TNF-ɑ) on the 2nd day after surgery – K=30.9% (p<0.001) and was observed within a week after surgery. Lidocaine and dexmedetomidine, as adjuvant components of multimodal anesthesia for total laryngectomy, when used together led to less immunosuppression, contributed to better rates of recovery of the immune status of laryngeal cancer patients compared  to the standard approach with the use of opioids.