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Institute for Infectious & Inflammatory Diseases

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Featured Project

Clinical Pharmacology, Effects of surgery and anesthesia on CNS, Neuroanesthesia

Alex Bekker, M.D., Ph.D.
Professor and Chair
  |  Department of Anesthesiology, Center for Immunity and Inflammation

Pilot study on the effects of intravenous ibuprofen on inflammatory responses in patients undergoing laparoscopic cholecystectomy. Correlation with clinical outcomes; Postoperative cognitive dysfunction; Clinical pharmacology of dexmedetomidine; Neurotoxicity of Anesthetics; Surgery and inflammatory responses

The association between surgery-induced neuroendocrine and inflammatory responses, anesthetic management, and short-term and long-term outcomes is being increasingly recognized by the scientific community. Surgery evokes a variety of metabolic, endocrinologic and immunologic changes that are collectively known as the “stress response”. Although the appropriate activation of an inflammatory cascade is essential for tissue reconstitution and infection control, it may lead to perioperative complications among the elderly (e.g. cognitive dysfunctions, myocardial and kidney injury), in neonates, and in patients with significant co- morbidity. In addition, mediators of inflammation may induce fatigue and prolong convalescence in otherwise healthy patients.

Anesthetic management may affect both the immunostimulatory and immunosuppressive mechanisms directly by modulating immune cell function or indirectly by attenuating the stress response. Thus, the choice of the anesthetic technique may influence clinical outcomes by perturbing the balance between proinflammatory and anti-inflammatory responses.

Our recent clinical trials suggest that intraoperative infusion of drugs that modulate the immune response such as dexmedetomidine (sedative) and ibuprofen (non steroidal anti-inflammatory drug), improve quality of recovery, shorten convalescence period, and reduce postoperative pain. Both treatments reduced the levels of stress related hormones and proinflammatory cytokine. These trials reveal an association between the concentrations of stress hormones (including inflammatory markers) and clinical outcomes.

Our future study will focus on examining the effect of treatments that modulate the stress response on the incidence of surgery related complications. The specific aims of our research include:

  1. Comparing immune responses to surgery and anesthesia in normal and in diseased states;
  2. Examining the effects of perioperative variables (e.g. blood transfusion) on the. functioning of neutrophils and cytokine release;
  3. Understanding the relationship between surgical stress and the inflammatory response is essential for improving care of surgical patients