Fever as a defense system of the body to surgical stress-Its physiological investigation and relationship to anesthesia

无论外科医生多么严格地进行无菌手术，90%的术后患者都会有明显的发烧。发现术后发热与IL-1(α、β)、IL-6、TNFα、INFα、MIP-1(α、β)等细胞因子密切相关。手术应激也会引起多种细胞因子的释放，特别是IL-6是已知的对手术应激强度和麻醉深度敏感的细胞因子。在本研究中，我们研究了手术中和术后发热与血浆细胞因子变化的相互作用。我们还研究了志愿者，每个人都被静脉注射了50000 IU/kg的白细胞介素2，2小时后再注射100,000 IU/kg。受试者随机分为3种剂量地氟烷诱导麻醉：(1)0.0MAC；(2)0.6MAC；(3)1.0MAC.地氟烷诱导的麻醉引起热原注射后积分体温和峰值体温呈剂量依赖性下降，1.0MAC基本消除发热。因此，麻醉诱导的热原反应抑制是发热是手术中对炎症的不一致临床反应的原因之一。

No matter how strictly the surgeons perform operation aseptically, 90% of the 1^<st> post-operative-day patients have significant fever. We found these post-operative fever had tight relationship with cytokines such as IL-1 (alpha, beta), IL-6, TNFalpha, INFalpha, MIP-1(alpha, beta). Surgical stress also provoke the release of various types of cytokines, especially IL-6 is known as sensitive cytokines to intensity of surgical stress and depth of anesthesia.In this study, we investigated the interactions between fever and plasma cytokines changes during surgery and post-operatively. We also studied volunteers, each was given an intravenous injection of 50,000 IU/kg of interleukin-2 followed 2 hours later by 100,000 IU/kg. Volunteers were assigned randomly to three doses of desflurane to induce anesthesia : (1) 0.0 minimum alveolar concentration (MAC ; control), (2) 0.6 MAC and (3) 1.0 MAC.Desflurane-induced anesthesia produced a dose-dependent decrease in integrated and peak core temperatures after administration for pyrogen, with 1.0 MAC essentially obliterating fever. Anesthetic-induced inhibition of the pyrogenic response is therefore one reason that fever is an inconsistent clinical response to inflammation during surgery.