Effects Of Fluid Therapy During Anesthesia On Peripheral Leukocyte Reaction In Patients Undergoing Laparoscopic Colorectal Cancer Resection Surgery

ObjectivesThe effects of fluid therapy during anesthesia on peripheral leukocyte reaction were studied in patients undergoing laparoscopic colorectal cancer resection surgery. All patients received general anesthesia. Lactate Ringer solution (LRS), hydroxyethyl starch130/0.4(HES), succinylated gelatin (GEL) and hypertonic hydroxyethyl starch (Home) were infused intravenously during anesthesia and operation. The peripheral blood leukocytes counts and their classifications were as indicators. The aim is to observed the effects of different fluid therapy on the immune and inflammatory responses, so as to provide a fluid therapy selection to such surgery.MethodsSeventy-seven patients hospitalized in department of surgery Guangdong Hospital of TCM for laparoscopic colorectal cancer resection surgery were enrolled the study. They were randomly divided into the flowing four groups, LRS (group L), HES (group H), GEL (group G) and HOME (250ml)+LRS (group M). All patients received a loading dose of8ml/kg LRS after open intravenous infusion. After the completion of anesthesia induction, all patients received their target fluid infusion by the rate of5-8ml·kg-1·h-1as followed, LRS in group L, HES in group H, GEL in group G and Home250ml followed LRS in group M. Patient’s heart rate, blood pressure and ET-C02were regular recorded before induction (T0),10min after anesthesia (T1),30min after anesthesia (T2),60min after anesthesia (T3),90min after anesthesia (T4),120min after anesthesia (T5) and at the end of surgery (T6). Peripheral white blood cells counts and their classification were detected at T0, T4, T6, the first postoperative day (T7) and the third postoperative day (T8).ResultThe overall changes of heart rate and systolic blood pressure in the four groups were similar during anesthesia and operation, i. e. decreased after anesthesia, maintained in a low level (P<0.05or P<0.01)during an operation, and back up to close to the preanesthesia level at the end of surgery. The change trends of diastolic and mean arterial blood pressure were similar. In contrast between T1and T4, it exist statistically significant difference (P<0.05or P<0.01). It did not see the differences of clinically meaningful change between groups. The values of ET-C02were maintained in the setting limits, and there were no any significant difference when compared between groups. The changes of the peripheral blood white blood cells were also similar, i.e. reduced slightly during surgery, increased significantly at the end of surgery and the first postoperative day, and decreased slightly at the third day, but still higher than the preanesthesia levels. There were no any different of White blood cell count between the four groups during the study. The NE count were also increased during surgery and the first and third postoperative day when compared to the preanesthesia (P<0.01). Whereas the LYM were significant decreased from T4to T8(P<0.05-0.01). MON were reduced slightly during anesthesia, but back to the preanesthesia level at the end of surgery, and tend to higher in the first and third postoperative day, with the LRS group significantly higher the preanesthesia (P<0.01). The similar increase were also seen in the Hom group (P<0.01).In the classification of white blood cells, the proportion of NE were significantly higher from T4to T8(P<0.05-0.01). And by contrast, the LYM percentage were consistent reduced significantly (P<0.05-0.01). From preanesthesia to the first postoperative day, the percentage of NE in group LRS was slightly lower than the other three groups, some existing significant differences, and the LYM was also existing higher than the other three groups in some time points (P<0.05). The percentage of the MON during surgery and at T6and T7were reduced statistically (P<0.05-0.01), and returned to the preanesthesia level at the third day. There were no significant differences when compared between the four groups. Conclusion1. Fluid therapy during laparoscopic.colorectal resection surgery under anesthesia, no matter infusion only with Lactated Ringer’s solution, or combined with hydroxyethyl starch, gelatin or high permeability hydroxyethyl starch solution, all can maintain circulatory function stability well.2. The characteristics of peripheral blood leukocyte response in this kind of surgery show that the total number of white blood cells reduces during anesthesia and surgery, then return to preanesthesia level at the end surgery. The leukocyte response increases to the highest level in the first postoperative day, then turn back in the third day.3. During the whole observation, the neutrophil count or its percentage are increased consistently and significant higher than the preanesthesia value, no meter the total number of white blood cells are increase or decrease. Whereas the lymphocytes are reduced continuously.4. The changes of white blood cells classification suggest that the body’s inflammation reaction enhance after anesthesia and operation. And the decrease of lymphocyte count indicates that the lymphocytes immune is declined, which may be unfavorable to the cancer patients.5. It seems that the effects of different fluid therapy on peripheral leukocyte count are no substantive difference in patients with colorectal cancer under general anesthesia for laparoscopic surgery.