COMPARISON OF THE EFFECTS OF 4 IV ANESTHETIC AGENTS ON POLYMORPHONUCLEAR LEUKOCYTE FUNCTION

Initial resistance to bacterial infection is mediated primarily by polymorphonuclear leucocytes (PMN). Anaesthetic agents have been reported to impair various aspects of PMN function. It is possible that the use of these agents to sedate critically ill patients may further compromise an already depressed host defence mechanism. A flow cytometric technique with fresh whole blood from 10 healthy volunteers was used. Phagocytic and respiratory burst activity of PMN incubated for 1 h with either propofol, thiopentone, midazolam or ketamine at both clinical plasma concentrations and 100 times this concentration were determined. Thiopentone at the higher concentration reduced both respiratory burst activity (mean peak channel 50.7 compared with control value of 77.6 (P < 0.0001)) and phagocytosis (mean peak channel 47.5 compared with 79.9 (P < 0.0001)). Ketamine at 100 times the clinical plasma concentration also reduced respiratory burst and phagocytosis, but this failed to reach statistical significance (P = 0.10 and P = 0.053, respectively). No significant depression occurred in the other groups. The results suggest that these i.v. anaesthetic agents, at clinically relevant concentrations, have minimal effects on PMN phagocytosis and oxygen free radical production. At higher concentrations thiopentone and ketamine may affect phagocytic function and thiopentone may impair intracellular cytolysis.