The effects of anesthesia and surgery on lymphocyte populations and function in infants and children

• Published in: Journal of pediatric surgery Vol. 24; no. 9; pp. 884 - 887
• Main Authors: Ward Platt, Martin P., Lovat, Penny E., Watson, J. Graham, Aynsley-Green, A.
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.09.1989; Elsevier
• Subjects: Age Factors; Anesthesia; Anesthesia, Inhalation - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; B-Lymphocytes - immunology; B-Lymphocytes - physiology; Biological and medical sciences; Cells, Cultured; Child; Child, Preschool; children; Concanavalin A; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Humans; Infant; Infant, Newborn; Intraoperative Period; Leukocyte Count; Lymphocyte Activation; lymphocytes in surgical stress; Lymphopenia - blood; Lymphopenia - etiology; Lymphopenia - immunology; Medical sciences; Pokeweed Mitogens; Surgical Procedures, Operative - adverse effects; Surgical stress; T-Lymphocytes - classification; T-Lymphocytes - immunology; T-Lymphocytes - physiology; Surgical stress; children; lymphocytes in surgical stress; Human; Postoperative; Surgery; Anesthesia; Child; Lymphocyte; Biological activity
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(89)80588-3

A study was designed to test the hypothesis that the lymphopenia caused by surgical stress in children may arise through selective depletion of one or more lymphocyte subsets. Blood samples from 22 children were taken preand postoperatively and 6, 12, 24, and 48 hours after surgery. Lymphocyte subsets were identified and counted using monoclonal antibodies and indirect immunofluorescence. By six hours postoperatively, the mean total lymphocyte count had fallen by 1.87×10 9/L ( P<.01); this was largely due to the fall in helper T cells (1.53×10 9/L, P<.01) and both counts remained depressed for at least 48 hours. The helper:suppressor ratio also fell, from 3.42 to 1.92 ( P<.01), but had recovered by 48 hours. Lymphocyte function as measured by the response to pokeweed mitogen and concanavalin A was also reduced six hours postoperatively. These changes were independent of age. Major surgery in infants and children causes a selective reduction in helper T lymphocyte numbers, helper:suppressor ratio, and lymphocyte function. This suggests that immune competence in the immediate postoperative period in children is reduced, as it is in adults. The duration of this and its relationship to infection are not yet known.