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Effects of different anesthesia modes on the stress hormones and immune factors of radical mastectomy patients

Objective: This study aims to examine the combined effects of laryngeal mask inhalation anesthesia and epidural anesthesia on stress hormones and immune factors of radical mastectomy patients.

Method: A total of 68 patients who underwent radical mastectomy from February 2015 to January 2017 participated in the study. They were divided into the control group (trachea cannula combined with traditional intravenous anesthesia) and observation group (laryngeal mask inhalation anesthesia combined with epidural anesthesia) according to the type of surgical anesthesia used. Peripheral venous blood cortisol and T-lymphocyte subpopulation (CD3+, CD4+, and CD8+) were tested before anesthesia administration (T1), immediately after anesthesia administration (T2), immediately after radical mastectomy (T3), and 3 days after radical mastectomy (T4). Differences in the stress hormones and immune factors of the patients were evaluated on the basis of the differences in cortisol concentrations and numerical changes in the CD3+% and CD4+/CD8+ values.

Results: The CD3+% and CD4+/CD8+ values of the two groups show no significant difference before the radical mastectomy but decrease considerably immediately after anesthesia administration. The decreases in the CD3+% and CD4+/CD8+ values of the control group are larger than those of the observation group and continue to decrease continuously after the radical mastectomy. However, the observation group still has higher CD3+% and CD4+/CD8+ values than the control group. Although the CD3+% and CD4+/CD8+ values decrease at varying extents 3 days after radical mastectomy, they remain higher than those obtained before radical mastectomy, and the observation group has higher CD3+% and CD4+/CD8+ values than the control group. The varying cortisol concentrations at different time points correspond to the T-lymphocytes. The cortisol concentrations increase considerably after the anesthesia, particularly in the control group increase continuously after radical mastectomy. The cortisol concentration of the observation group is lower than that of the control group. Although the cortisol concentrations decrease at varying extents 3 days after radical mastectomy, they remain higher than those obtained before radical mastectomy. The cortisol concentrations of the observation group are lower than those of the control group.

Conclusions: Simultaneously administering anesthesia through laryngeal mask inhalation and epidural anesthesia can significantly reduce damages to the body immunities of patients treated with radical mastectomy. This approach results in smaller stress damages compared with anesthesia administration through total intravenous endotracheal intubation and is thus beneficial to postoperative rehabilitation. Furthermore, this approach can reduce postoperative secondary infection and probable harm to patients.

Author(s): Zhi Zhang, Yan Zhang, Shu-Biao Wu, Tie-Li Dong