Cytokine Profile in Patients Undergoing Minimally Invasive Surgery with Balanced Anesthesia José Eduardo B. Orosz, 1 Mariana G. Braz, 2 Márjorie A. Golim, 3 Márcio Antônio A. Barreira, 1 Denise Fecchio, 2 Leandro G. Braz, 1 and José Reinaldo C. Braz 1,4 Abstract—Patients undergoing surgical procedure develop an inflammatory response due to surgical trauma that may be modulated by anesthetics. The aim of this study was to investigate the cytokine profile in the plasma of adult patients who underwent minimally invasive surgery with balanced anes- thesia with propofol, fentanyl, and sevoflurane. The study included 15 healthy patients scheduled for tympanoplasty or septoplasty under balanced anesthesia. Blood samples were drawn at four time points: before anesthesia, before surgery, 120 min after anesthesia induction, and on the first postoperative day. Plasma interleukin (IL)-1β, -2, -4, -6, -8, -10, -12, TNF-α, and INF-γ levels were assessed by flow cytometry. IL-6 levels were elevated on the day after the surgery (p <0.001). All other cytokines did not change either during or after balanced anesthesia (p >0.05). In conclusion, balanced anesthesia with propofol, fentanyl, and sevoflurane anesthesia is not associated with intraoperative changes in the plasma cytokines in healthy patients undergoing minimally invasive otorhinological surgeries. Consi- dering IL-6 results, a postoperative inflammatory response may have occurred due to surgical stress. KEY WORDS: balanced anesthesia; sevoflurane; minor surgical procedures; cytokines; flow cytometry. INTRODUCTION Inflammation is a fundamental process for tissue reconstitution, but an overactive inflammatory response can be more dangerous than protective, leading to postop- erative complications, such as postoperative infections, wound healing disturbances, and multiple organ dysfunc- tions [1]. Surgery, trauma, and anesthetics may contribute to the inflammation. Thus, it is important to acknowledge what kind of inflammatory responses surgical procedure can cause and also what can be done to attenuate this inflammatory response perioperatively to prevent morbidity. Surgical procedures can influence the immune system through activation of the autonomic nervous system and/or the hypothalamic–pituitary–adrenal axis [2]. Anesthetic drugs may be associated with perioperative immunosup- pression either indirectly by modulation of the stress response or directly due to their effects on cell-mediated immunity. Thus, the anesthetics can alter functions of immunocompetent cells and also change the gene expres- sion of inflammatory mediators [3]. Balanced anesthesia is a technique of general anes- thesia, which many drugs are used to produce the different components of anesthesia (i.e., analgesia, amnesia, muscle relaxation, and abolition of autonomic reflexes with maintenance of homeostasis). In balanced anesthesia, an opioid, a hypnotic, a neuromuscular blocking, and an inhaled anesthetic are utilized. Sevoflurane [fluoromethyl- 2,2,2-trifluoro-1-(trifluoromethyl) ethyl ether] (SEVO) is 1 Department of Anesthesiology, Botucatu Medical School, UNESP, Universidade Estadual Paulista, District of Rubiao Junior, Botucatu, São Paulo, BrazilCEP: 18618-970 2 Department of Anesthesiology, Botucatu Medical School, UNESP, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil 3 Blood Center, Botucatu Medical School, UNESP, Universidade Estadual Paulista, Botucatu, São Paulo, Brazil 4 To whom correspondence should be addressed at Department of Anesthesiology, Botucatu Medical School, UNESP, Universidade Estadual Paulista, District of Rubiao Junior, Botucatu, São Paulo, BrazilCEP: 18618-970. E-mail: jbraz@fmb.unesp.br ABBREVIATIONS: SEVO, Sevoflurane; IL, Interleukin; TNF-α, Tumor necrosis factor alpha; INF-γ, Interferon gamma; ASA, American Society of Anesthesiologists; SpO 2 , Peripheral oxygen saturation; P ET CO 2 , End-tidal of carbon dioxide; PACU, Post-Anesthesia Care Unit; CBA, Cytometric bead array; PerCP, Peridinin chlorophyll-protein complex; PE, Phycoerithrin; ANOVA, Analysis of variance; SD, Standard deviations; ELISA, Enzyme-linked immunosorbent assay; EDTA, Ethyl- enediamine tetraacetic acid; BMI, Body mass index; N 2 O, Nitrous oxide; Th1/Th2, T helper 1/T helper 2 lymphocytes 0360-3997/12/0600-1807/0 # 2012 Springer Science+Business Media, LLC Inflammation, Vol. 35, No. 6, December 2012 ( # 2012) DOI: 10.1007/s10753-012-9501-2 1807